MEDICARE: ROBERT ROSENBERG P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CH6255	FL

General Provider Information

NPI Number	:	1093975724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT ROSENBERG P.A.

Provider Business Mailing Address
First Line	:	250 S RONALD REAGAN BLVD
Second Line	:	SUITE 104
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5466
Country	:	US
Telephone Number	:	407-767-6466
Fax Number	:	407-767-2437

Provider Business Practice Location Address
First Line	:	250 S RONALD REAGAN BLVD
Second Line	:	SUITE 104
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5466
Country	:	US
Telephone Number	:	407-767-6466
Fax Number	:	407-767-2437

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN/OWNER
Name	:	DR. ROBERT ROSENBERG
Credential	:	D.C.
Telephone Number	:	407-767-6466

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	12/12/2012

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