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General NPI Number Information
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NPI Number | 1376051169
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Entity Type | Organization
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Legal Business Name | ROZELL CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 06/03/2024
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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 | OWNER
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Name | DR. NICHOLAS ROZELL
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Credential | DC
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Telephone | 618-307-9383
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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