Healthcare Provider Details

I. General information

NPI: 1073599536
Provider Name (Legal Business Name): KATHERINE ROSE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18877 JEB STUART HWY
STUART VA
24171
US

IV. Provider business mailing address

PO BOX 945
STUART VA
24171-0945
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-7047
  • Fax: 276-694-6039
Mailing address:
  • Phone: 276-694-7047
  • Fax: 276-694-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001368
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: