Brian L Roscoe, DC, LLC
Organization Active NPI Chiropractor · Grand Haven, MI
NPI 1174701957 · NPPES record last updated Feb 4, 2008
Key facts
- NPI
- 1174701957
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301005392 (MI)
- Legal business name
- BRIAN L ROSCOE, DC, LLC
- Practice address
- 727 Washington Ave
Grand Haven, MI 49417-1458 - Phone
- (616) 847-1444
- Fax
- (616) 847-1711
- NPI assigned
- Feb 4, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Brian L Roscoe, DC
- Title
- Owner
- Phone
- (616) 847-1444
Practitioners 1
-
Brian L Roscoe, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130131000187 | MI | Part B Supplier - Clinic/Group Practice | 5395999221 |
Receives reassigned benefits from 1 practitioner Practice locations: Grand Haven, MI |
National Provider Directory
Locations
727 Washington Ave
Grand Haven, MI 49417
Phone (616) 847-1444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2301005392 | MI | Yes |
Addresses
Primary practice location
727 Washington Ave
Grand Haven, MI 49417-1458
Mailing address
727 Washington Ave
Grand Haven, MI 49417-1458
Phone (616) 847-1444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0G01069 | Other | BLUE CROSS |
Other names
- Roscoe Chiropractic Wellness Center
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 Feb 4, 2008. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.