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Individual
THOMAS D ROSE
Active
Individual
THOMAS D ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
164775-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005935097
AETNA
—
01
—
22780
PEHP
UT
01
—
36360
DMBA
UT
01
—
870395551RO1
EMIA
UT
01
—
ALTIUS
58303
UT
Enumeration date
07/12/2006
Last updated
10/16/2007
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