Provider Demographics
NPI:1376647867
Name:ROSENTHAL, PETER I (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:I
Last Name:ROSENTHAL
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 1:527 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5444
Mailing Address - Country:US
Mailing Address - Phone:203-550-3269
Mailing Address - Fax:508-675-1503
Practice Address - Street 1:50 G A R HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3215
Practice Address - Country:US
Practice Address - Phone:508-677-1500
Practice Address - Fax:508-677-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor