Individual
MR. DOUGLAS ROOSEVELT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ND, LMT, EMT-P
Contact information
Practice address
301 S PROSPECT RD STE 1A, BLOOMINGTON, IL 61704-4909
(309) 531-4584
Mailing address
1223 KENNETH DR, BLOOMINGTON, IL 61704-2587
(309) 531-4584
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
IL
Other
Enumeration date
05/06/2025
Last updated
05/06/2025
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