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NPI Code Detail

MEDICARE: DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN

MEDICARE: DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2111NN0400XNeurology Chiropractor4867CO
3111NN1001XNutrition Chiropractor4867CO
4111NP0017XPediatric Chiropractor4867CO
5111NR0200XRadiology Chiropractor4867CO
6111NS0005XSports Physician Chiropractor4867CO
7111NX0100XOccupational Health Chiropractor4867CO
8111NX0800XOrthopedic Chiropractor4867CO
9111NR0400XRehabilitation Chiropractor4867CO
10111N00000XChiropractor4867CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2COA106967OTHERCOMEDICARE PTAN DR AVILA
8COA107185OTHERCOMEDICARE PTAN DR. WILSON

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14867OTHERCOCOLORADO LICENSE UPIN
3841603517OTHERCOTAX I.D.
41245248400OTHERCONPI DR AVILA
51821363557OTHERCOGROUP NPI
61295797413OTHERCONPI DR WILSON
7COA106966OTHERGROUP PTAN

General Provider Information

NPI Number : 1245248400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN
Provider Business Mailing Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Provider Business Practice Location Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 03/17/2020

Similar Medicare Providers

1821363557 — AVILA INTEGRATIVE MEDICINE, INC.
Practice Location Address:
3960 IVYWOOD LN
PUEBLO, CO
81005-2567
Practice Phone: 719-565-1276
Practice Fax: 719-565-2313
1528405990 — LEAH WILSON CMT
Practice Location Address:
3942 IVYWOOD LN
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1144620063 — ANDREA PINEDA CCC-SLP
Practice Location Address:
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PUEBLO, CO
81005-2567
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Practice Fax: 719-565-2313
1013381698 — KAMALA RIES SLP
Practice Location Address:
3960 IVYWOOD LN
PUEBLO, CO
81005-2567
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Practice Fax: 719-565-2313
1407327539 — REBEKAH NORTH BCBA
Practice Location Address:
3960 IVYWOOD LN
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81005-2567
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Practice Fax: 719-565-2313
1801359203 — CARRIE RAYE GRAVATT M.A., CCC-SLP
Practice Location Address:
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