Provider Demographics
NPI:1902360506
Name:ROSE CHIROPRACTIC CORPORATION, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSE CHIROPRACTIC CORPORATION, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-818-4306
Mailing Address - Street 1:2635 CAMINO DEL RIO S STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3729
Mailing Address - Country:US
Mailing Address - Phone:619-818-4306
Mailing Address - Fax:619-828-1030
Practice Address - Street 1:2635 CAMINO DEL RIO S STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3729
Practice Address - Country:US
Practice Address - Phone:619-818-4306
Practice Address - Fax:619-828-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty