MEDICARE: ROSE CHIROPRACTIC & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11145	TX

General Provider Information

NPI Number	:	1427316025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE CHIROPRACTIC & WELLNESS

Provider Business Mailing Address
First Line	:	3529 HERITAGE TRACE PKWY
Second Line	:	155
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3529 HERITAGE TRACE PKWY
Second Line	:	155
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4970
Country	:	US
Telephone Number	:	214-704-4144
Fax Number	:	972-317-4196

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. DUSTIN ROSE
Credential	:	D.C.
Telephone Number	:	214-704-4144

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	07/02/2012

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