Provider Demographics
NPI:1912215625
Name:ROSUM, JEFFREY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:ROSUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 DIXIE HWY
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1771
Mailing Address - Country:US
Mailing Address - Phone:502-449-5046
Mailing Address - Fax:502-449-5048
Practice Address - Street 1:5135 DIXIE HWY
Practice Address - Street 2:SUITE 25
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1771
Practice Address - Country:US
Practice Address - Phone:502-449-5046
Practice Address - Fax:502-449-5048
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5252111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation