Provider Demographics
NPI:1932689148
Name:ROSE, JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:ROSE
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 1:180 E WARREN DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WA
Mailing Address - Zip Code:98592-9647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 E WARREN DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WA
Practice Address - Zip Code:98592-9647
Practice Address - Country:US
Practice Address - Phone:360-610-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor