Provider Demographics
NPI:1174511596
Name:ROSENBERG, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
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 1:250 S RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5466
Mailing Address - Country:US
Mailing Address - Phone:407-767-6466
Mailing Address - Fax:407-767-2437
Practice Address - Street 1:250 S RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5466
Practice Address - Country:US
Practice Address - Phone:407-767-6466
Practice Address - Fax:407-767-2437
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU09421Medicare ID - Type Unspecified