Healthcare Provider Details

I. General information

NPI: 1336116458
Provider Name (Legal Business Name): ROSE A DUCASSE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST SUITE B
GRANTS NM
87020-2703
US

IV. Provider business mailing address

PO BOX 540
GRANTS NM
87020-0540
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-5377
  • Fax: 505-287-5508
Mailing address:
  • Phone: 505-287-5377
  • Fax: 505-287-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 8548
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1749
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: