Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 173704-1202 | UT |
NPI | 1669471405 |
---|---|
Provider Name | Dr. Ronald L Rosquist |
First Address | Sandy, UT 84094-3600 |
Second Address | Sandy, UT 84094-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 15/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870395551005 | (05) | UT |
T78100 | (02) | UT |