Provider Demographics
NPI:1255476867
Name:VERTREES, ROBERT GLENN (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:VERTREES
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27940 VALLEY CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082
Mailing Address - Country:US
Mailing Address - Phone:760-749-8211
Mailing Address - Fax:
Practice Address - Street 1:27940 VALLEY CENTER ROAD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082
Practice Address - Country:US
Practice Address - Phone:760-749-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U18610Medicare UPIN