Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH11519 | FL |
N | 111NS0005X | Chiropractic Sports Physician | 2014015330 | MO |
NPI | 1124430301 |
---|---|
Provider Name | Dr. Luis Alejandro Rosado |
First Address | Destin, FL 32541-2348 |
Second Address | Kirkwood, MO 63122-6169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2014 |
Last Update Date | 12/05/2016 |