Provider Demographics
NPI:1174560346
Name:ROSENLUND, KEVIN AUBREY (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:AUBREY
Last Name:ROSENLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-0215
Mailing Address - Country:US
Mailing Address - Phone:208-922-5057
Mailing Address - Fax:208-922-5087
Practice Address - Street 1:675 W 4TH ST
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1939
Practice Address - Country:US
Practice Address - Phone:208-922-5057
Practice Address - Fax:208-922-5087
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA -942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU83724Medicare UPIN
ID350052067Medicare ID - Type Unspecified