Provider Demographics
NPI:1396048047
Name:ROSADO, PEDRO JUAN JR (DC)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JUAN
Last Name:ROSADO
Suffix:JR
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 1:9906 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1858
Mailing Address - Country:US
Mailing Address - Phone:813-510-3986
Mailing Address - Fax:813-510-3989
Practice Address - Street 1:9906 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1858
Practice Address - Country:US
Practice Address - Phone:813-510-3986
Practice Address - Fax:813-510-3989
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor