Provider Demographics
NPI:1134375751
Name:ROSQUIST GROUP P C
Entity type:Organization
Organization Name:ROSQUIST GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-8770
Mailing Address - Street 1:3409 W 12600 S
Mailing Address - Street 2:#200
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065
Mailing Address - Country:US
Mailing Address - Phone:801-676-8770
Mailing Address - Fax:801-676-8772
Practice Address - Street 1:3409 W 12600 S
Practice Address - Street 2:#200
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-676-8770
Practice Address - Fax:801-676-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174224-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005842Medicare UPIN