Provider Demographics
NPI:1083713929
Name:GILBERT, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GILBERT
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 1:901 E KIMBERLY RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1622
Mailing Address - Country:US
Mailing Address - Phone:563-322-5739
Mailing Address - Fax:
Practice Address - Street 1:901 E KIMBERLY RD
Practice Address - Street 2:SUITE 17
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1622
Practice Address - Country:US
Practice Address - Phone:563-322-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16403Medicare ID - Type Unspecified