Provider Demographics
NPI:1275721284
Name:ROBART REHABILITATION AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:ROBART REHABILITATION AND WELLNESS CENTER INC
Other - Org Name:ROBART CHIROPRACTIC CARE CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DALEY
Authorized Official - Last Name:ROBART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-438-7200
Mailing Address - Street 1:912 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-2101
Mailing Address - Country:US
Mailing Address - Phone:573-438-7200
Mailing Address - Fax:
Practice Address - Street 1:912 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-2101
Practice Address - Country:US
Practice Address - Phone:573-438-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO756252300Medicaid
MOU66778Medicare UPIN
MO756252300Medicaid