Provider Demographics
NPI:1750725818
Name:ROSENBERG, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
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 1:423 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-2233
Mailing Address - Country:US
Mailing Address - Phone:732-996-3463
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 610
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3665
Practice Address - Country:US
Practice Address - Phone:202-733-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030165111N00000X
MDS03741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor