MEDICARE: MARK ALLAN ROSENBAUM D.C.

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	2301004304	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950C950380	OTHER	MI	BCN
2	950C950380	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1811996259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALLAN ROSENBAUM D.C.

Provider Business Mailing Address
First Line	:	4403 W MICHIGAN AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5866
Country	:	US
Telephone Number	:	269-375-6565
Fax Number	:	269-375-7168

Provider Business Practice Location Address
First Line	:	4403 W MICHIGAN AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5866
Country	:	US
Telephone Number	:	269-375-6565
Fax Number	:	269-375-7168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/27/2011

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Directions to “ MARK ALLAN ROSENBAUM D.C.” Practice Location

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