Provider Demographics
NPI:1215263108
Name:ROSE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:ROSE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-888-8183
Mailing Address - Street 1:34024 W 8 MILE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5209
Mailing Address - Country:US
Mailing Address - Phone:248-888-8183
Mailing Address - Fax:
Practice Address - Street 1:34024 W 8 MILE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5209
Practice Address - Country:US
Practice Address - Phone:248-888-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU81744Medicare UPIN