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General NPI Number Information
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NPI Number | 1811609688
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Entity Type | Individual
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Provider Name | ROBERTO ULLOA JR. DC
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Gender | Male
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 515 18TH AVE
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City | EAST MOLINE
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State | IL
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Zip | 61244-2037
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Country | US
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Telephone | 619-410-1406
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Fax |
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Provider Business Mailing Address
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Address Line | 700 EAGLE RIDGE RD
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City | LE CLAIRE
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State | IA
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Zip | 52753-9593
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Country | US
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Telephone | 563-289-3242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 115414
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License Number State | IA
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