Provider Demographics
NPI:1205880374
Name:ROSELYN, LILY H (DC)
Entity type:Individual
Prefix:DR
First Name:LILY
Middle Name:H
Last Name:ROSELYN
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 1:2507 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9297
Mailing Address - Country:US
Mailing Address - Phone:503-842-7789
Mailing Address - Fax:503-842-0089
Practice Address - Street 1:2507 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9208
Practice Address - Country:US
Practice Address - Phone:503-842-7789
Practice Address - Fax:503-842-0089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR109546Medicare ID - Type Unspecified