MEDICARE: ROSELAWN CHIROPRACTIC CENTER INC.

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	2107	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350048971	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27333-0002	OTHER	OH	CINCINNATI HEALTH PLAN
3	000000015445	OTHER	OH	NEW ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110461728-00	OTHER	OH	WORKER'S COMP

General Provider Information

NPI Number	:	1457525784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSELAWN CHIROPRACTIC CENTER INC.

Provider Business Mailing Address
First Line	:	7733 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2142
Country	:	US
Telephone Number	:	513-821-5757
Fax Number	:	513-679-4662

Provider Business Practice Location Address
First Line	:	7733 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2142
Country	:	US
Telephone Number	:	513-821-5757
Fax Number	:	513-679-4662

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN MICHEAL GULLA
Credential	:
Telephone Number	:	513-821-5757

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	07/17/2008

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