Provider Demographics
NPI:1780857623
Name:THOMAS D ROSE DC PC
Entity Type:Organization
Organization Name:THOMAS D ROSE DC PC
Other - Org Name:SEVIER VALLEY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-896-8820
Mailing Address - Street 1:489 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1822
Mailing Address - Country:US
Mailing Address - Phone:435-896-8820
Mailing Address - Fax:435-896-0334
Practice Address - Street 1:489 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1822
Practice Address - Country:US
Practice Address - Phone:435-896-8820
Practice Address - Fax:435-896-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164775-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032704OtherAMERICAN SPECIALTY HEALTH
UT53034192077001OtherBLUE CROSS BLUE SHIELD
UT36360OtherDESERET MUTUAL
UT530341920016Medicaid
UT870395551RO1OtherEDUCATORS MUTUAL
UT870395551RO1OtherEDUCATORS MUTUAL