Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH11031 | FL |
NPI | 1003245721 |
---|---|
Provider Name | Dr. Chad Michael Rose |
First Address | The Villages, FL 32162-5604 |
Second Address | The Villages, FL 32162-5604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2013 |
Last Update Date | 16/06/2015 |