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General NPI Number Information
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NPI Number | 1114475290
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Entity Type | Individual
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Provider Name | NICHOLAS MOREY ROZELL DC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1 COUNTRY CLUB VW STE 101
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3693
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Country | US
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Telephone | 618-307-9383
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Fax | 888-979-6608
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Provider Business Mailing Address
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Address Line | 1 COUNTRY CLUB VW STE 101
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3693
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Country | US
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Telephone | 618-307-9383
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Fax | 888-979-6608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038013030
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License Number State | IL
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