Provider Demographics
NPI:1497775985
Name:ERIK ROSENBERG CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ERIK ROSENBERG CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:SAN DIEGO SPORTS AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:MINTON
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-279-2121
Mailing Address - Street 1:7612 LINDA VISTA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5313
Mailing Address - Country:US
Mailing Address - Phone:858-279-2121
Mailing Address - Fax:858-279-6751
Practice Address - Street 1:7612 LINDA VISTA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5313
Practice Address - Country:US
Practice Address - Phone:858-279-2121
Practice Address - Fax:858-279-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27952Medicare ID - Type UnspecifiedMEDICARE