Provider Demographics
NPI:1033116686
Name:ROSEN, LARRY P (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:P
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 1:688 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2751
Mailing Address - Country:US
Mailing Address - Phone:508-791-5164
Mailing Address - Fax:508-791-8769
Practice Address - Street 1:688 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2751
Practice Address - Country:US
Practice Address - Phone:508-791-5164
Practice Address - Fax:508-791-8769
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35243Medicare ID - Type Unspecified
MAT58060Medicare UPIN