Healthcare Provider Details

I. General information

NPI: 1194840769
Provider Name (Legal Business Name): JARED C. ROSENBERG, DC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MEDICAL CENTER BLVD 300A
WEBSTER TX
77598-4242
US

IV. Provider business mailing address

251 MEDICAL CENTER BLVD 300A
WEBSTER TX
77598-4242
US

V. Phone/Fax

Practice location:
  • Phone: 281-554-5308
  • Fax: 281-605-5539
Mailing address:
  • Phone: 281-554-5308
  • Fax: 281-605-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10436
License Number StateTX

VIII. Authorized Official

Name: DR. JARED CHARLES ROSENBERG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 281-554-5308