Provider Demographics
NPI:1932984697
Name:ROSE, DEVIN GRAHAM (DC)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:GRAHAM
Last Name:ROSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SUMMER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3726
Mailing Address - Country:US
Mailing Address - Phone:914-257-1058
Mailing Address - Fax:
Practice Address - Street 1:440 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1420
Practice Address - Country:US
Practice Address - Phone:802-655-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0134192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor