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General NPI Number Information
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NPI Number | 1518638881
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Entity Type | Individual
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Provider Name | GEORGANNA ROSE DC, ND
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Gender | Female
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Dates
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Enumeration Date | 09/25/2021
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1S132 SUMMIT AVE STE 300
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3942
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Country | US
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Telephone | 773-848-2302
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 CHELTENHAM DR APT 1D
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City | GLEN ELLYN
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State | IL
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Zip | 60137-6061
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Country | US
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Telephone |
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Fax |
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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 | 038.013690
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License Number State | IL
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