Healthcare Provider Details

I. General information

NPI: 1205772894
Provider Name (Legal Business Name): GREGORY ROSE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 AVENIDA DE LA PLATA
OCEANSIDE CA
92056-5802
US

IV. Provider business mailing address

4810 FERNDALE CUT OFF RD
LITTLE ROCK AR
72223-9425
US

V. Phone/Fax

Practice location:
  • Phone: 760-594-2366
  • Fax:
Mailing address:
  • Phone: 760-594-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number29583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: