Provider Demographics
NPI:1457917999
Name:LOPEZ, ROSA ANGELICA (DC)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:ANGELICA
Last Name:LOPEZ
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 1:2039 S OLD HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3724
Mailing Address - Country:US
Mailing Address - Phone:636-724-9444
Mailing Address - Fax:636-724-9440
Practice Address - Street 1:2039 S OLD HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3724
Practice Address - Country:US
Practice Address - Phone:636-724-9444
Practice Address - Fax:636-724-9440
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019015069OtherLICENCE NUMBER