Provider Demographics
NPI:1568969616
Name:ALEXXANDRIA JO ROUSH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ALEXXANDRIA JO ROUSH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSH
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:740-645-4314
Mailing Address - Street 1:3407 MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2934
Mailing Address - Country:US
Mailing Address - Phone:614-991-0224
Mailing Address - Fax:
Practice Address - Street 1:3407 MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123
Practice Address - Country:US
Practice Address - Phone:614-991-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770959686OtherNPI