Healthcare Provider Details

I. General information

NPI: 1467510610
Provider Name (Legal Business Name): ROBERT BRADFORD BERUBE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11837 BLANDFIELD ST
HENRICO VA
23233-2425
US

IV. Provider business mailing address

11837 BLANDFIELD ST
HENRICO VA
23233-2425
US

V. Phone/Fax

Practice location:
  • Phone: 804-372-8277
  • Fax:
Mailing address:
  • Phone: 804-372-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: