Provider Demographics
NPI:1669471405
Name:ROSQUIST, RONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:ROSQUIST
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 1:834 E 9400 S
Mailing Address - Street 2:SUITE 57
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3600
Mailing Address - Country:US
Mailing Address - Phone:801-571-3333
Mailing Address - Fax:801-571-4449
Practice Address - Street 1:834 E 9400 S
Practice Address - Street 2:SUITE 57
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3600
Practice Address - Country:US
Practice Address - Phone:801-571-3333
Practice Address - Fax:801-571-4449
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173704-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551005Medicaid
UT870395551005Medicaid
UT000005849Medicare ID - Type Unspecified