Healthcare Provider Details

I. General information

NPI: 1558631812
Provider Name (Legal Business Name): ROBERT A. CLEMENTS, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S UNION ST
KOKOMO IN
46901-5598
US

IV. Provider business mailing address

925 S UNION ST
KOKOMO IN
46901-5598
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-1313
  • Fax:
Mailing address:
  • Phone: 765-452-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number382
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT A CLEMENTS
Title or Position: CHIRPRATIC
Credential: D.C.
Phone: 765-452-1330