Provider Demographics
NPI:1609938141
Name:ROSE, GAIL RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:RUTH
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 89TH STREET NW
Mailing Address - Street 2:SUITE T
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-713-7985
Mailing Address - Fax:941-795-1143
Practice Address - Street 1:611 89TH STREET NW
Practice Address - Street 2:SUITE T
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-713-7985
Practice Address - Fax:941-795-1143
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22614OtherBLUE CROSS BLUE SHIELD
FLU12133Medicare UPIN
FL22614OtherBLUE CROSS BLUE SHIELD