Provider Demographics
NPI:1821279654
Name:ROSENBERG, HERBERT DIETMAR (DC)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:DIETMAR
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 1:288 N IRONWOOD DR STE 108
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3830
Mailing Address - Country:US
Mailing Address - Phone:480-735-1034
Mailing Address - Fax:480-983-1275
Practice Address - Street 1:288 N IRONWOOD DR STE 108
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3830
Practice Address - Country:US
Practice Address - Phone:480-735-1034
Practice Address - Fax:480-983-1275
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor