Healthcare Provider Details

I. General information

NPI: 1215149778
Provider Name (Legal Business Name): ROBERT A. RAMIREZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 N BROAD ST
PHILADELPHIA PA
19141-2108
US

IV. Provider business mailing address

PO BOX 305
MOUNT LAUREL NJ
08054-0305
US

V. Phone/Fax

Practice location:
  • Phone: 215-324-5853
  • Fax: 215-324-6764
Mailing address:
  • Phone: 609-980-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC007402L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: