Provider Demographics
NPI:1215700729
Name:ROSE, AMANDA MAY (DC, MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BAUER AVE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2552
Mailing Address - Country:US
Mailing Address - Phone:631-335-5962
Mailing Address - Fax:
Practice Address - Street 1:1500 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3500
Practice Address - Country:US
Practice Address - Phone:631-543-1440
Practice Address - Fax:631-736-7490
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor