Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 01809 | MD |
NPI | 1366507493 |
---|---|
Provider Name | Dr. Rick Rosa |
First Address | Springfield, VA 22152-1505 |
Second Address | Temple Hills, MD 20748-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U85598 | (02) | MD |