MEDICARE: RONALD P ROSENHECK D.C.

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	111N00000X	Chiropractor	CH0006141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22560	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1467579318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD P ROSENHECK D.C.

Provider Business Mailing Address
First Line	:	1234 NE 4TH AVE
Second Line	:	SUITE B
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1925
Country	:	US
Telephone Number	:	954-764-4940
Fax Number	:	954-764-4942

Provider Business Practice Location Address
First Line	:	1234 NE 4TH AVE
Second Line	:	SUITE B
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1925
Country	:	US
Telephone Number	:	954-764-4940
Fax Number	:	954-764-4942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	05/02/2011

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