Provider Demographics
NPI:1275501751
Name:STUBBLEFIELD, ROBERT L (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:STUBBLEFIELD
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 1:1820 SAVANNAH HWY
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6276
Mailing Address - Country:US
Mailing Address - Phone:843-766-5112
Mailing Address - Fax:843-766-5123
Practice Address - Street 1:1820 SAVANNAH HWY
Practice Address - Street 2:SUITE A-1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6276
Practice Address - Country:US
Practice Address - Phone:843-766-5112
Practice Address - Fax:843-766-5123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0811Medicaid
5217Medicare ID - Type Unspecified