Provider Demographics
NPI:1740281039
Name:ROSE, MICHELLE SUSANNE (DC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUSANNE
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 1:1190 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4814
Mailing Address - Country:US
Mailing Address - Phone:757-468-5444
Mailing Address - Fax:757-468-2091
Practice Address - Street 1:1190 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4814
Practice Address - Country:US
Practice Address - Phone:757-468-5444
Practice Address - Fax:757-468-2091
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI0005362725OtherAETNA
VA1205733OtherFIRST HEALTH
VA44-00166OtherUHC
VA393538OtherBCBS
VA393538OtherBCBS
VA350001025Medicare PIN
VA44-00166OtherUHC