Provider Demographics
NPI:1750795712
Name:ROSE FAMILY CHIROPRACTIC WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ROSE FAMILY CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-237-7655
Mailing Address - Street 1:395 LANDA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5407
Mailing Address - Country:US
Mailing Address - Phone:830-629-3101
Mailing Address - Fax:830-626-8245
Practice Address - Street 1:395 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5407
Practice Address - Country:US
Practice Address - Phone:830-629-3101
Practice Address - Fax:830-626-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty