Provider Demographics
NPI:1275630535
Name:MASTELLER, ROBERT M (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:MASTELLER
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 1:421 21ST AVE
Mailing Address - Street 2:SUITE 41
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1469
Mailing Address - Country:US
Mailing Address - Phone:303-772-9600
Mailing Address - Fax:303-772-9308
Practice Address - Street 1:421 21ST AVE
Practice Address - Street 2:SUITE 41
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1469
Practice Address - Country:US
Practice Address - Phone:303-772-9600
Practice Address - Fax:303-772-9308
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1353111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic