Provider Demographics
NPI:1104959824
Name:ROSENSTEIN, MATTHEW FREDRIC (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDRIC
Last Name:ROSENSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2403
Mailing Address - Country:US
Mailing Address - Phone:415-686-9119
Mailing Address - Fax:111-111-1111
Practice Address - Street 1:2215 CHESTNUT ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2607
Practice Address - Country:US
Practice Address - Phone:415-686-9119
Practice Address - Fax:111-111-1111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11645111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11645Medicare ID - Type Unspecified