Provider Demographics
NPI:1295287258
Name:ROSEN, DANA (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:LEIGH
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:908 ACAPULCO ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3804
Mailing Address - Country:US
Mailing Address - Phone:949-285-2033
Mailing Address - Fax:
Practice Address - Street 1:908 ACAPULCO ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3804
Practice Address - Country:US
Practice Address - Phone:949-285-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor