Provider Demographics
NPI:1972834083
Name:ROSENBURG CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ROSENBURG CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:ROSENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-931-3100
Mailing Address - Street 1:4917 MARYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2644
Mailing Address - Country:US
Mailing Address - Phone:618-931-3100
Mailing Address - Fax:618-931-3123
Practice Address - Street 1:4917 MARYVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2644
Practice Address - Country:US
Practice Address - Phone:618-931-3100
Practice Address - Fax:618-931-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty