Provider Demographics
NPI:1154544484
Name:ROSE, DARCI (DC)
Entity type:Individual
Prefix:MS
First Name:DARCI
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2522
Mailing Address - Country:US
Mailing Address - Phone:805-489-5661
Mailing Address - Fax:805-489-5992
Practice Address - Street 1:121 N HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2522
Practice Address - Country:US
Practice Address - Phone:805-489-5661
Practice Address - Fax:805-489-5992
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19588Medicare ID - Type Unspecified