Provider Demographics
NPI:1134234651
Name:ROSEN, RICHARD JOEL (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOEL
Last Name:ROSEN
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 1:9825 MARINA BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6628
Mailing Address - Country:US
Mailing Address - Phone:561-883-0090
Mailing Address - Fax:561-883-0676
Practice Address - Street 1:9825 MARINA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6628
Practice Address - Country:US
Practice Address - Phone:561-883-0090
Practice Address - Fax:561-883-0676
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592231708OtherTAX ID
FL800184276OtherTAX ID