Provider Demographics
NPI:1326697046
Name:ROSAS, HOWARD CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:CHRISTOPHER
Last Name:ROSAS
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 1:40 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3927
Mailing Address - Country:US
Mailing Address - Phone:845-857-5542
Mailing Address - Fax:
Practice Address - Street 1:1353 GOLD STAR HWY STE 106
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-460-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor