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General NPI Number Information
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NPI Number | 1245296680
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Entity Type | Individual
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Provider Name | TED D ROSEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 409 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4915
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Country | US
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Telephone | 209-527-5346
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Fax | 209-527-0124
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Provider Business Mailing Address
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Address Line | 409 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4915
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Country | US
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Telephone | 209-527-5346
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Fax | 209-527-0124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | DC014744
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License Number State | CA
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