Provider Demographics
NPI:1881904456
Name:ROSE CHIROPRACTIC
Entity type:Organization
Organization Name:ROSE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-249-2188
Mailing Address - Street 1:2702 INTERNATIONAL LN STE 208
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3117
Mailing Address - Country:US
Mailing Address - Phone:608-249-2188
Mailing Address - Fax:608-249-2253
Practice Address - Street 1:2037 WINNEBAGO STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5370
Practice Address - Country:US
Practice Address - Phone:608-249-2188
Practice Address - Fax:608-249-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837500Medicaid
WI75989Medicare PIN