Active NPI
Mitchell Barry Rose, D.C.
- Sports Physician Chiropractor
- Bristol, CT
National Provider Identifier
1154367415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 490
- Practice address
- 281 N Main St
Bristol, CT 06010-4971 - Phone
- (860) 582-6111
- Fax
- (860) 582-5499
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 490 | CT | Primary |
Addresses
Primary practice location
281 N Main St
Bristol, CT 06010-4971
Mailing address
57 High Ridge Holw
Avon, CT 06001-3200
Phone (860) 675-1690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000490 | CT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154367415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 HIGH RIDGE HOLW",
"city": "AVON",
"state": "CT",
"postal_code": "060013200",
"telephone_number": "860-675-1690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "281 N MAIN ST",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060104971",
"telephone_number": "860-582-6111",
"fax_number": "860-582-5499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "MITCHELL",
"middle_name": "BARRY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CT",
"license": "490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.