Provider Demographics
NPI:1205471323
Name:ROOSE, KATHERINE RACHELLE (DC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RACHELLE
Last Name:ROOSE
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 1:5 KIMBALL CT APT 503
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6919
Mailing Address - Country:US
Mailing Address - Phone:419-302-7100
Mailing Address - Fax:
Practice Address - Street 1:1446 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2743
Practice Address - Country:US
Practice Address - Phone:761-769-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor