Provider Demographics
NPI:1902846959
Name:MCLAURIN, ROSA MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MARIE
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N CENTER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086
Mailing Address - Country:US
Mailing Address - Phone:501-676-3600
Mailing Address - Fax:501-676-3601
Practice Address - Street 1:1300 N CENTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086
Practice Address - Country:US
Practice Address - Phone:501-676-3600
Practice Address - Fax:501-676-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11057000040OtherQUAL CHOICE
5T331OtherBCBS
11057000040OtherQUAL CHOICE
5T331OtherBCBS