Provider Demographics
NPI:1659332237
Name:ROSA, DINA (DC)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 PROSPERITY AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4312
Mailing Address - Country:US
Mailing Address - Phone:703-876-5600
Mailing Address - Fax:703-876-6234
Practice Address - Street 1:2750 PROSPERITY AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4312
Practice Address - Country:US
Practice Address - Phone:703-876-5600
Practice Address - Fax:703-876-6234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor