Provider Demographics
NPI:1093975724
Name:ROBERT ROSENBERG P.A.
Entity Type:Organization
Organization Name:ROBERT ROSENBERG P.A.
Other - Org Name:ROSENBERG CHIROPRACTIC WELLNESS AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-767-6466
Mailing Address - Street 1:250 S RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5466
Mailing Address - Country:US
Mailing Address - Phone:407-767-6466
Mailing Address - Fax:407-767-2437
Practice Address - Street 1:250 S RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5466
Practice Address - Country:US
Practice Address - Phone:407-767-6466
Practice Address - Fax:407-767-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6255111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty