Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC003375L | PA |
NPI | 1518906668 |
---|---|
Provider Name | Dr. Robert J Kustra |
First Address | Blue Bell, PA 19422-1535 |
Second Address | Blue Bell, PA 19422-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00001260825 02 | UNITED HEALTHCARE (01) | PA |
000504030 | HIGHMARK BLUE SHIELD (01) | PA |
001384519 | HIGHMARK BLUE SHIELD (01) | PA |
0109289000 | BC PERSONAL CHOICE (01) | PA |
0843387 | AETNA (01) | PA |
1031454 | (05) | PA |