Healthcare Provider Details

I. General information

NPI: 1134249980
Provider Name (Legal Business Name): ROBERT WILLIAM CANOVA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31941 DOVE CANYON DR
TRABUCO CANYON CA
92679-3718
US

IV. Provider business mailing address

31941 DOVE CANYON DR.
TRABUCO CANYON CA
92679
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-1984
  • Fax: 949-293-1984
Mailing address:
  • Phone: 949-293-1984
  • Fax: 949-293-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC20539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: