Provider Demographics
NPI:1780022574
Name:ROSEBUSH, CRAIG J (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:ROSEBUSH
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 1:980 FOREST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3388
Mailing Address - Country:US
Mailing Address - Phone:207-747-4938
Mailing Address - Fax:
Practice Address - Street 1:980 FOREST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3388
Practice Address - Country:US
Practice Address - Phone:207-747-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor