Provider Demographics
NPI:1063605608
Name:ROSTBERG CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity type:Organization
Organization Name:ROSTBERG CHIROPRACTIC & ACUPUNCTURE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:ROSTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-381-9355
Mailing Address - Street 1:4121 W 83RD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5300
Mailing Address - Country:US
Mailing Address - Phone:913-381-9355
Mailing Address - Fax:913-381-9359
Practice Address - Street 1:4121 W 83RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5300
Practice Address - Country:US
Practice Address - Phone:913-381-9355
Practice Address - Fax:913-381-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSX860000Medicare PIN