Provider Demographics
NPI:1467579318
Name:ROSENHECK, RONALD P (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:P
Last Name:ROSENHECK
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 1:1234 NE 4TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1925
Mailing Address - Country:US
Mailing Address - Phone:954-764-4940
Mailing Address - Fax:954-764-4942
Practice Address - Street 1:1234 NE 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1925
Practice Address - Country:US
Practice Address - Phone:954-764-4940
Practice Address - Fax:954-764-4942
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22560OtherBLUE CROSS BLUE SHIELD