MEDICARE: DR. STEPHANIE MARIE ROSE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301008119	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P108668	OTHER	MI	BCN

General Provider Information

NPI Number	:	1558353664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE MARIE ROSE DC

Provider Business Mailing Address
First Line	:	16597 MIDDLEBELT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-3335
Country	:	US
Telephone Number	:	734-422-2252
Fax Number	:	248-471-0964

Provider Business Practice Location Address
First Line	:	32595 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3207
Country	:	US
Telephone Number	:	248-888-8183
Fax Number	:	248-471-0964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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