Provider Demographics
NPI:1114018041
Name:ORNELAS, ROBERT KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:ORNELAS
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 1:20421 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3042
Mailing Address - Country:US
Mailing Address - Phone:714-970-1025
Mailing Address - Fax:714-970-7347
Practice Address - Street 1:20421 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3042
Practice Address - Country:US
Practice Address - Phone:714-970-1025
Practice Address - Fax:714-970-7347
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954063482OtherTAX ID NUMBER
CAT18410Medicare UPIN
CADC16788Medicare ID - Type UnspecifiedCHIROPRACTIC