Provider Demographics
NPI:1063850790
Name:ROSA, RAIJOSE (DC)
Entity Type:Individual
Prefix:MR
First Name:RAIJOSE
Middle Name:
Last Name:ROSA
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 1:9161 NARCOOSSEE RD # B208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5764
Mailing Address - Country:US
Mailing Address - Phone:407-350-1594
Mailing Address - Fax:321-396-7667
Practice Address - Street 1:9161 NARCOOSSEE RD # B208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5764
Practice Address - Country:US
Practice Address - Phone:407-350-1594
Practice Address - Fax:321-396-7667
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor