Provider Demographics
NPI:1083638654
Name:MESCH, ROBERT J (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MESCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0305
Mailing Address - Country:US
Mailing Address - Phone:319-665-9066
Mailing Address - Fax:319-665-9084
Practice Address - Street 1:1295 N JORDAN ST
Practice Address - Street 2:STE 6
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8020
Practice Address - Country:US
Practice Address - Phone:319-665-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0458836Medicaid
IAV06499Medicare UPIN
IA0458836Medicaid