Provider Demographics
NPI:1194796524
Name:ROSE, DEBORAH C (DC)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:C
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 CARDINAL WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6665
Mailing Address - Country:US
Mailing Address - Phone:239-284-1322
Mailing Address - Fax:239-304-9563
Practice Address - Street 1:4670 CARDINAL WAY STE 301
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6665
Practice Address - Country:US
Practice Address - Phone:732-530-7229
Practice Address - Fax:732-530-4665
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00678200111N00000X
FLCH14518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381493900Medicaid
FL70131ZMedicare ID - Type Unspecified