Healthcare Provider Details

I. General information

NPI: 1912215625
Provider Name (Legal Business Name): JEFFREY PAUL ROSUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 DIXIE HWY SUITE 25
LOUISVILLE KY
40216-1771
US

IV. Provider business mailing address

5135 DIXIE HWY SUITE 25
LOUISVILLE KY
40216-1771
US

V. Phone/Fax

Practice location:
  • Phone: 502-449-5046
  • Fax: 502-449-5048
Mailing address:
  • Phone: 502-449-5046
  • Fax: 502-449-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5252
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: