Provider Demographics
NPI:1649357617
Name:ROSENBERG, DAVID E (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
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 1:291 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1719
Mailing Address - Country:US
Mailing Address - Phone:617-969-4999
Mailing Address - Fax:617-969-4706
Practice Address - Street 1:291 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1719
Practice Address - Country:US
Practice Address - Phone:617-969-4999
Practice Address - Fax:617-969-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1605089Medicaid
MAY35290Medicare ID - Type Unspecified
MAT58088Medicare UPIN