Provider Demographics
NPI:1831115666
Name:ROSENTHAL, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ROSENTHAL
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 1:19251 PRESTON RD
Mailing Address - Street 2:#505
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8552
Mailing Address - Country:US
Mailing Address - Phone:972-322-2280
Mailing Address - Fax:
Practice Address - Street 1:3530 FOREST LN
Practice Address - Street 2:SUITE 290
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7910
Practice Address - Country:US
Practice Address - Phone:972-322-2280
Practice Address - Fax:972-733-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10053111N00000X
MACH 2276111N00000X
NYX009109-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36980OtherBLUE CROSS/ BLUE SHIELDMA
TX608210OtherBLUE CROSS/BLUE SHIELD
MARO Y45658Medicare ID - Type Unspecified
MAU96977Medicare UPIN