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General NPI Number Information
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NPI Number | 1598159576
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Entity Type | Organization
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Legal Business Name | ROSE WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 910 OLD CAMP RD SUITE 92
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City | THE VILLAGES
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State | FL
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Zip | 32162-5604
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Country | US
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Telephone | 352-775-2180
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Fax | 352-775-2930
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Provider Business Mailing Address
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Address Line | 910 OLD CAMP RD SUITE 92
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City | THE VILLAGES
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State | FL
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Zip | 32162-5604
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Country | US
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Telephone | 386-334-0133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAD ROSE
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Credential | D.C.
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Telephone | 352-775-2180
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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 | CH11031
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License Number State | FL
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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 | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 053562
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License Number State | FL
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