Provider Demographics
NPI:1518012657
Name:ROSEN, MARC WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:WAYNE
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 1:22272 WOODSET LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3805
Mailing Address - Country:US
Mailing Address - Phone:561-392-5555
Mailing Address - Fax:561-852-9925
Practice Address - Street 1:7300 W CAMINO REAL
Practice Address - Street 2:SUITE 116
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5512
Practice Address - Country:US
Practice Address - Phone:561-392-5555
Practice Address - Fax:561-852-9925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor