Provider Demographics
NPI:1922276559
Name:ROSEN, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 DONLON ST
Mailing Address - Street 2:#9
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5639
Mailing Address - Country:US
Mailing Address - Phone:805-650-0130
Mailing Address - Fax:805-650-0132
Practice Address - Street 1:1445 DONLON ST
Practice Address - Street 2:#9
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5639
Practice Address - Country:US
Practice Address - Phone:805-650-0130
Practice Address - Fax:805-650-0132
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor