Provider Demographics
NPI:1134325228
Name:ADELIA ROBERT INC
Entity Type:Organization
Organization Name:ADELIA ROBERT INC
Other - Org Name:SOUTH PADRE ISLAND CHIROPRACTIC AND WELLNESS CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-943-1333
Mailing Address - Street 1:600 SANTA ISABEL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2650
Mailing Address - Country:US
Mailing Address - Phone:956-943-1333
Mailing Address - Fax:956-943-1595
Practice Address - Street 1:600 SANTA ISABEL BLVD
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2650
Practice Address - Country:US
Practice Address - Phone:956-943-1333
Practice Address - Fax:956-943-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83140GOtherBLUE CROSS BLUE SHIELD GR
TX00044FMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER