Provider Demographics
NPI:1780713388
Name:ROSENBERG, NEVIN M (DC)
Entity type:Individual
Prefix:DR
First Name:NEVIN
Middle Name:M
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 1:19215 SE 34TH ST
Mailing Address - Street 2:STE. #106-161
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8829
Mailing Address - Country:US
Mailing Address - Phone:541-728-3431
Mailing Address - Fax:
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1887
Practice Address - Country:US
Practice Address - Phone:360-693-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60506510111N00000X
OR5549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor