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General NPI Number Information
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NPI Number | 1134348675
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Entity Type | Organization
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Legal Business Name | ROSSELLO FAMILY CHIROPRACTIC, PA
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD SUITE B122
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-464-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 MITCHELLVILLE RD SUITE B122
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-464-9400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE GRACE ROSSELLO
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Credential | D.C.
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Telephone | 301-464-9400
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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 | S01133
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License Number State | MD
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