Brian L Roscoe, DC
Individual provider Active NPI Chiropractor · Grand Haven, MI
NPI 1043339765 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043339765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301005392 (MI)
- Practice address
- 727 Washington St
Grand Haven, MI 49417-1458 - Phone
- (616) 847-1444
- Fax
- (616) 847-1711
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Sherman College of Straight Chiropractic, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
727 Washingotn Ave
Grand Haven, MI 49417-1458
Phone (616) 847-1444
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130131000214 | MI | Practitioner - Chiropractic | 8820242753 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC03333 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301005392 | MI | Yes |
| Chiropractor | 111N00000X | MC03333 | NJ |
Addresses
Primary practice location
727 Washington St
Grand Haven, MI 49417-1458
Mailing address
727 Washington St
Grand Haven, MI 49417-1458
Phone (616) 847-1444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BR 005392 | Other | MI | PPOM |
| 141B11174 | Medicaid | MI | |
| 0G01069 | Other | MI | BLUE CROSS |
Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.