Provider Demographics
NPI:1932380607
Name:J.R. ROSSER, JR. D.C, S.C.
Entity Type:Organization
Organization Name:J.R. ROSSER, JR. D.C, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-741-6400
Mailing Address - Street 1:1276 W SPRING ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3304
Mailing Address - Country:US
Mailing Address - Phone:847-741-6400
Mailing Address - Fax:847-741-6926
Practice Address - Street 1:1276 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3304
Practice Address - Country:US
Practice Address - Phone:847-741-6400
Practice Address - Fax:847-741-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4515124OtherBCBS IL
IL681740Medicare PIN
IL4515124OtherBCBS IL