Provider Demographics
NPI:1194534032
Name:DEROSA, JOSIE (DC)
Entity type:Individual
Prefix:DR
First Name:JOSIE
Middle Name:
Last Name:DEROSA
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 1:6423 SHADY BROOK LN APT 2170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1311
Mailing Address - Country:US
Mailing Address - Phone:262-290-7082
Mailing Address - Fax:
Practice Address - Street 1:2240 MARKET PLACE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-8099
Practice Address - Country:US
Practice Address - Phone:972-556-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor