Provider Demographics
NPI:1700948403
Name:ROSE, BARRY LESLIE (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LESLIE
Last Name:ROSE
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 1:6638 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1231
Mailing Address - Country:US
Mailing Address - Phone:407-298-9211
Mailing Address - Fax:407-298-9227
Practice Address - Street 1:6638 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1231
Practice Address - Country:US
Practice Address - Phone:407-298-9211
Practice Address - Fax:407-298-9227
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6164111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22472OtherCHIROPRACTIC
FL22472YMedicare ID - Type UnspecifiedCHIROPRACTIC
FLU12715Medicare UPIN