Healthcare Provider Details

I. General information

NPI: 1871963256
Provider Name (Legal Business Name): ROSELLE SERVICE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E IRVING PARK RD
ROSELLE IL
60172-2004
US

IV. Provider business mailing address

211 E IRVING PARK RD
ROSELLE IL
60172-2004
US

V. Phone/Fax

Practice location:
  • Phone: 224-655-6555
  • Fax: 224-653-9395
Mailing address:
  • Phone: 224-655-6555
  • Fax: 224-653-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT JOSEPH KENNY
Title or Position: OWNER
Credential: DC
Phone: 815-717-8355