Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH11539 | FL |
NPI | 1184247009 |
---|---|
Provider Name | Robert Gatlin |
First Address | Winter Haven, FL 33881-4753 |
Second Address | Winter Haven, FL 33881-4753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2020 |
Last Update Date | 27/05/2020 |