Provider Demographics
NPI:1871963256
Name:ROSELLE SERVICE COMPANY LLC
Entity type:Organization
Organization Name:ROSELLE SERVICE COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-717-8355
Mailing Address - Street 1:211 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2004
Mailing Address - Country:US
Mailing Address - Phone:224-655-6555
Mailing Address - Fax:224-653-9395
Practice Address - Street 1:211 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2004
Practice Address - Country:US
Practice Address - Phone:224-655-6555
Practice Address - Fax:224-653-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty