MEDICARE: DR. ERIK JASON ROSSELAND D.C.

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	5632	AZ
2	111N00000X	Chiropractor	6909	TX

General Provider Information

NPI Number	:	1780728006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK JASON ROSSELAND D.C.

Provider Business Mailing Address
First Line	:	3670 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1658
Country	:	US
Telephone Number	:	520-444-1937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1658
Country	:	US
Telephone Number	:	520-444-1937
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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