Provider Demographics
NPI:1871835496
Name:ROSE, JARED (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:ROSE
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 1:1181 71ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3645
Mailing Address - Country:US
Mailing Address - Phone:305-834-7900
Mailing Address - Fax:786-523-0599
Practice Address - Street 1:1181 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3645
Practice Address - Country:US
Practice Address - Phone:305-834-7900
Practice Address - Fax:786-523-0599
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor