Provider Demographics
NPI:1194737635
Name:ROSEN, MICHAEL BARRY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:ROSEN
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 1:6303 OLEANDER DR
Mailing Address - Street 2:SUITE #102A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3590
Mailing Address - Country:US
Mailing Address - Phone:910-313-1322
Mailing Address - Fax:910-313-1323
Practice Address - Street 1:6303 OLEANDER DR
Practice Address - Street 2:SUITE #102A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3590
Practice Address - Country:US
Practice Address - Phone:910-313-1322
Practice Address - Fax:910-313-1323
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC32283OtherPARTNERS
NC7908232Medicaid
NC08232OtherBLUE CROSS/BLUE SHIELD
NC2452735Medicare ID - Type Unspecified