Provider Demographics
NPI:1669694899
Name:ROSEMOND CHIROPRACTIC HEALTH CENTER, INC
Entity type:Organization
Organization Name:ROSEMOND CHIROPRACTIC HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSEMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-837-9355
Mailing Address - Street 1:17701 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1347
Mailing Address - Country:US
Mailing Address - Phone:313-837-9355
Mailing Address - Fax:313-837-3179
Practice Address - Street 1:17701 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1347
Practice Address - Country:US
Practice Address - Phone:313-837-9355
Practice Address - Fax:313-837-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301300277261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H25285OtherBCBSM
MI0H25285Medicare ID - Type Unspecified