Provider Demographics
NPI:1427316025
Name:ROSE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:ROSE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-704-4144
Mailing Address - Street 1:3529 HERITAGE TRACE PKWY
Mailing Address - Street 2:155
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3529 HERITAGE TRACE PKWY
Practice Address - Street 2:155
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4970
Practice Address - Country:US
Practice Address - Phone:214-704-4144
Practice Address - Fax:972-317-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty