Provider Demographics
NPI:1831538040
Name:ROSCOE, JARED LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:LYNNE
Last Name:ROSCOE
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 1:205 N GARDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4124
Mailing Address - Country:US
Mailing Address - Phone:727-447-4647
Mailing Address - Fax:727-443-3195
Practice Address - Street 1:205 N GARDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4124
Practice Address - Country:US
Practice Address - Phone:727-447-4647
Practice Address - Fax:727-443-3195
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHK630ZMedicare PIN