Provider Demographics
NPI:1659329720
Name:ROSNER, JEFFREY H (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:ROSNER
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 1:822 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2687
Mailing Address - Country:US
Mailing Address - Phone:239-574-3432
Mailing Address - Fax:239-574-3098
Practice Address - Street 1:822 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2687
Practice Address - Country:US
Practice Address - Phone:239-574-3432
Practice Address - Fax:239-574-3098
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050268500Medicaid
FL592459318OtherEIN
FL050268500Medicaid
FLT55992Medicare UPIN