Provider Demographics
NPI:1598878159
Name:ROSENBERG, JAMES R (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ROSENBERG
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 1:1150 W STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5327
Mailing Address - Country:US
Mailing Address - Phone:208-384-9070
Mailing Address - Fax:208-384-9057
Practice Address - Street 1:1150 W STATE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5327
Practice Address - Country:US
Practice Address - Phone:208-384-9070
Practice Address - Fax:208-384-9057
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806980000Medicaid
ID806980000Medicaid
IDV0266Medicare UPIN