Provider Demographics
NPI:1326566167
Name:DAVID ROSENTHAL, DC, PA
Entity Type:Organization
Organization Name:DAVID ROSENTHAL, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-350-9777
Mailing Address - Street 1:3530 FOREST LN STE 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7996
Mailing Address - Country:US
Mailing Address - Phone:214-350-9777
Mailing Address - Fax:972-733-3112
Practice Address - Street 1:3530 FOREST LN STE 104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7996
Practice Address - Country:US
Practice Address - Phone:214-350-9777
Practice Address - Fax:972-733-3112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID ROSENTHAL, D.C, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10053111N00000X
NY009109111N00000X
MA2276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty