Provider Demographics
NPI:1245296680
Name:ROSEN, TED D (DC)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:D
Last Name:ROSEN
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 1:409 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4915
Mailing Address - Country:US
Mailing Address - Phone:209-527-5346
Mailing Address - Fax:209-527-0124
Practice Address - Street 1:409 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4915
Practice Address - Country:US
Practice Address - Phone:209-527-5346
Practice Address - Fax:209-527-0124
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-01-07
Deactivation Date:2007-11-05
Deactivation Code:
Reactivation Date:2008-01-07
Provider Licenses
StateLicense IDTaxonomies
CADC014744111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health