Healthcare Provider Details

I. General information

NPI: 1174560346
Provider Name (Legal Business Name): KEVIN AUBREY ROSENLUND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W 4TH ST
KUNA ID
83634-1939
US

IV. Provider business mailing address

PO BOX 215
KUNA ID
83634-0215
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-5057
  • Fax: 208-922-5087
Mailing address:
  • Phone: 208-922-5057
  • Fax: 208-922-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA -942
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: