Provider Demographics
NPI:1205908571
Name:ROSENBUSH, JASON JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:ROSENBUSH
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 1:1201 GILMORE AVE
Mailing Address - Street 2:SUITE F-5B
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2424
Mailing Address - Country:US
Mailing Address - Phone:507-452-4417
Mailing Address - Fax:507-452-4417
Practice Address - Street 1:1201 GILMORE AVENUE
Practice Address - Street 2:SUITE F-5B
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987
Practice Address - Country:US
Practice Address - Phone:507-452-4417
Practice Address - Fax:507-452-4417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
272M1R0OtherBCBS OF MN
MN500055600Medicaid
MN500055600Medicaid
272M1R0OtherBCBS OF MN
U96775Medicare UPIN