Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0005861 | FL |
NPI | 1811964414 |
---|---|
Provider Name | Dr. Robert A Ville |
First Address | Merritt Island, FL 32952-4977 |
Second Address | Merritt Island, FL 32952-4977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T94036 | (02) | FL |