Provider Demographics
NPI:1922042563
Name:GREGORY, ROSANNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:M
Last Name:GREGORY
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 1:1330 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2713
Mailing Address - Country:US
Mailing Address - Phone:860-644-2437
Mailing Address - Fax:860-644-8590
Practice Address - Street 1:1330 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2713
Practice Address - Country:US
Practice Address - Phone:860-644-2437
Practice Address - Fax:860-644-8590
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001149OtherCHIROPRACTIC LICENSE
CT001149OtherCHIROPRACTIC LICENSE
U54590Medicare UPIN
350001302Medicare ID - Type Unspecified