MEDICARE: DR. ROBERT J REDMON D.C.

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
1	111N00000X	Chiropractor	DC14206	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326018698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J REDMON D.C.

Provider Business Mailing Address
First Line	:	8555 AERO DR STE 109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1744
Country	:	US
Telephone Number	:	619-284-3321
Fax Number	:	858-715-3909

Provider Business Practice Location Address
First Line	:	3019 POLK AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2609
Country	:	US
Telephone Number	:	619-284-3321
Fax Number	:	619-280-9070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	11/26/2019

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