Provider Demographics
NPI:1124102132
Name:ROLLINS, ROSEANN C (DC)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:C
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ROSEANN
Other - Middle Name:
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3901 ROSWELL RD.
Mailing Address - Street 2:STE 208
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062
Mailing Address - Country:US
Mailing Address - Phone:770-509-9717
Mailing Address - Fax:770-509-8796
Practice Address - Street 1:3901 ROSWELL RD.
Practice Address - Street 2:STE 208
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:770-509-9717
Practice Address - Fax:770-509-8796
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I356367OtherMEDICARE PTAN
35ZCCMJMedicare UPIN
GA202I356367OtherMEDICARE PTAN