Provider Demographics
NPI:1598077315
Name:ROSEWOOD CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ROSEWOOD CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-371-1886
Mailing Address - Street 1:5555 N. LAMAR BLVD.
Mailing Address - Street 2:SUITE C121
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1073
Mailing Address - Country:US
Mailing Address - Phone:512-371-1886
Mailing Address - Fax:512-371-1665
Practice Address - Street 1:5555 N. LAMAR BLVD.
Practice Address - Street 2:SUITE C121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-371-1886
Practice Address - Fax:512-371-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11195111N00000X
TX11423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty