Provider Demographics
NPI:1003905274
Name:ROSEN, MARTIN G (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:ROSEN
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 1:471 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5935
Mailing Address - Country:US
Mailing Address - Phone:781-237-6673
Mailing Address - Fax:781-996-4347
Practice Address - Street 1:471 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5935
Practice Address - Country:US
Practice Address - Phone:781-237-6673
Practice Address - Fax:781-996-4347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612875Medicaid
MAY35460OtherBLUE CROSS BLUE SHIELD
MAY35460OtherBLUE CROSS BLUE SHIELD