Provider Demographics
NPI:1750640942
Name:MARC W. ROSEN, D.C.,P.A.
Entity Type:Organization
Organization Name:MARC W. ROSEN, D.C.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-392-5555
Mailing Address - Street 1:7300 W CAMINO REAL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5512
Mailing Address - Country:US
Mailing Address - Phone:561-392-5555
Mailing Address - Fax:561-852-9925
Practice Address - Street 1:7300 W CAMINO REAL
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5512
Practice Address - Country:US
Practice Address - Phone:561-392-5555
Practice Address - Fax:561-852-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55195OtherBLUE CROSS BLUE SHIELD