Provider Demographics
NPI:1689713208
Name:ROSE, LORI SINGER (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:SINGER
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21054 SHERMAN WAY
Mailing Address - Street 2:STE 245
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4513
Mailing Address - Country:US
Mailing Address - Phone:818-995-7950
Mailing Address - Fax:818-449-4869
Practice Address - Street 1:21054 SHERMAN WAY
Practice Address - Street 2:STE 245
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303
Practice Address - Country:US
Practice Address - Phone:818-995-7950
Practice Address - Fax:818-449-4869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU24689Medicare UPIN