Provider Demographics
NPI:1104832203
Name:DEFINIS, ROBERT PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PETER
Last Name:DEFINIS
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 1:410 DEL PRADO BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2243
Mailing Address - Country:US
Mailing Address - Phone:239-574-4564
Mailing Address - Fax:
Practice Address - Street 1:410 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2243
Practice Address - Country:US
Practice Address - Phone:239-574-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88936Medicare ID - Type Unspecified