Provider Demographics
NPI:1356754592
Name:ROSENTHAL CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:ROSENTHAL CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-776-0595
Mailing Address - Street 1:202 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-1636
Mailing Address - Country:US
Mailing Address - Phone:815-776-0595
Mailing Address - Fax:815-776-0595
Practice Address - Street 1:202 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1636
Practice Address - Country:US
Practice Address - Phone:815-776-0595
Practice Address - Fax:815-776-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007243302F00000X
WI4551012302F00000X
IL038011927302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization