Provider Demographics
NPI:1548279425
Name:ROSENBAUM, ALLAN J (DC)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:J
Last Name:ROSENBAUM
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 1:208 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-2766
Mailing Address - Country:US
Mailing Address - Phone:940-759-2005
Mailing Address - Fax:940-759-2006
Practice Address - Street 1:208 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2766
Practice Address - Country:US
Practice Address - Phone:940-759-2005
Practice Address - Fax:940-759-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609515Medicare PIN
TXT15634Medicare UPIN