Provider Demographics
NPI:1609220318
Name:ROSSEAU, DEVON MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:MICHAEL
Last Name:ROSSEAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 E 29TH PL APT 2042
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4045
Mailing Address - Country:US
Mailing Address - Phone:810-751-5899
Mailing Address - Fax:
Practice Address - Street 1:14151 E CEDAR AVE UNIT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-367-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP0284273OtherASR HEALTH BENEFITS PPO