MEDICARE: ROBERT E MIDDLETON JR. DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	038-006866	IL

General Provider Information

NPI Number	:	1740276336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E MIDDLETON JR. DC

Provider Business Mailing Address
First Line	:	212 E MAIN ST
Second Line	:	PO BOX 18
City	:	ARCOLA
State	:	IL
Zip	:	61910-1416
Country	:	US
Telephone Number	:	217-268-4743
Fax Number	:	217-268-4743

Provider Business Practice Location Address
First Line	:	212 E MAIN ST
Second Line	:
City	:	ARCOLA
State	:	IL
Zip	:	61910-1416
Country	:	US
Telephone Number	:	217-268-4743
Fax Number	:	217-268-4743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/12/2010

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