Healthcare Provider Details

I. General information

NPI: 1700948403
Provider Name (Legal Business Name): BARRY LESLIE ROSE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6638 OLD WINTER GARDEN RD
ORLANDO FL
32835-1231
US

IV. Provider business mailing address

6638 OLD WINTER GARDEN RD
ORLANDO FL
32835-1231
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-9211
  • Fax: 407-298-9227
Mailing address:
  • Phone: 407-298-9211
  • Fax: 407-298-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCH6164
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6164
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH6164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: