Provider Demographics
NPI:1811555212
Name:CORE CONCEPTS CHIROPRACTIC BY ROSELLE
Entity Type:Organization
Organization Name:CORE CONCEPTS CHIROPRACTIC BY ROSELLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-723-4178
Mailing Address - Street 1:42882 TRURO PARISH DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148
Mailing Address - Country:US
Mailing Address - Phone:703-723-4178
Mailing Address - Fax:703-723-5424
Practice Address - Street 1:42882 TRURO PARISH DR
Practice Address - Street 2:SUITE 207
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148
Practice Address - Country:US
Practice Address - Phone:703-723-4178
Practice Address - Fax:703-723-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty