Provider Demographics
NPI:1457525784
Name:ROSELAWN CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:ROSELAWN CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:GULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-821-5757
Mailing Address - Street 1:7733 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2142
Mailing Address - Country:US
Mailing Address - Phone:513-821-5757
Mailing Address - Fax:513-679-4662
Practice Address - Street 1:7733 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2142
Practice Address - Country:US
Practice Address - Phone:513-821-5757
Practice Address - Fax:513-679-4662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSELAWN CHIROPRACTIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH27333-0002OtherCINCINNATI HEALTH PLAN
OH350048971OtherRAILROAD MEDICARE
OH000000015445OtherNEW ANTHEM
OH0990503Medicaid
OH110461728-00OtherWORKER'S COMP
OH0990503Medicaid
OH000000015445OtherNEW ANTHEM
OH350048971OtherRAILROAD MEDICARE
OH=========-01OtherWORKER'S COMP