Provider Demographics
NPI:1174992101
Name:ERIC J ROSEEN DC LLC
Entity type:Organization
Organization Name:ERIC J ROSEEN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-739-2621
Mailing Address - Street 1:654 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2020
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:844-283-4933
Practice Address - Street 1:654 BEACON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2020
Practice Address - Country:US
Practice Address - Phone:627-536-1161
Practice Address - Fax:844-283-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty