Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 111N00000X | Chiropractor | 4867 | CO |
N | 111NN0400X | Neurology | 4867 | CO |
N | 111NN1001X | Nutrition | 4867 | CO |
N | 111NP0017X | Pediatric Chiropractor | 4867 | CO |
N | 111NR0200X | Radiology | 4867 | CO |
N | 213ER0200X | Radiology | 4867 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | 4867 | CO |
N | 111NS0005X | Chiropractic Sports Physician | 4867 | CO |
N | 111NX0100X | Occupational Health | 4867 | CO |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 4867 | CO |
NPI | 1245248400 |
---|---|
Provider Name | Dr. Robert Joseph Avila |
First Address | Pueblo, CO 81005-2567 |
Second Address | Pueblo, CO 81005-2567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 17/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245248400 | NPI DR AVILA (01) | CO |
1295797413 | NPI DR WILSON (01) | CO |
1821363557 | GROUP NPI (01) | CO |
4867 | COLORADO LICENSE UPIN (01) | CO |
841603517 | TAX I.D. (01) | CO |
COA106966 | GROUP PTAN (01) | |
COA106967 | MEDICARE PTAN DR AVILA (01) | CO |
COA107185 | MEDICARE PTAN DR. WILSON (01) | CO |