Provider Demographics
NPI:1366507493
Name:ROSA, RICK (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
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 1:6201 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1505
Mailing Address - Country:US
Mailing Address - Phone:703-569-2533
Mailing Address - Fax:
Practice Address - Street 1:4269 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1715
Practice Address - Country:US
Practice Address - Phone:301-316-2111
Practice Address - Fax:301-316-5382
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01809111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU85598Medicare UPIN
MD490876Medicare ID - Type Unspecified