Provider Demographics
NPI:1851589907
Name:ROSE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:ROSE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-264-7948
Mailing Address - Street 1:PO BOX 230427
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0427
Mailing Address - Country:US
Mailing Address - Phone:334-264-7948
Mailing Address - Fax:334-264-8616
Practice Address - Street 1:2941 ZELDA RD STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2699
Practice Address - Country:US
Practice Address - Phone:334-264-7948
Practice Address - Fax:334-264-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-01480OtherBCBS
K375OtherMEDICARE GROUP NUMBER