Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC23970 | CA |
NPI | 1174530687 |
---|---|
Provider Name | Philip S. Rosen |
First Address | Tarzana, CA 91356 |
Second Address | Tarzana, CA 91356-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC23970 | LICENSE NUMBER (01) | CA |