Provider Demographics
NPI:1619681277
Name:ROSA, JARED ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ANTHONY
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 1:569 HEALTH BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1499
Mailing Address - Country:US
Mailing Address - Phone:386-258-9800
Mailing Address - Fax:386-238-0092
Practice Address - Street 1:569 HEALTH BLVD STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1499
Practice Address - Country:US
Practice Address - Phone:386-258-9800
Practice Address - Fax:386-238-0092
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor