Provider Demographics
NPI:1275742314
Name:FARIES, ROBERT PAUL (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:FARIES
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 1:5240 MARGARET LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-2914
Mailing Address - Country:US
Mailing Address - Phone:409-350-9027
Mailing Address - Fax:
Practice Address - Street 1:7060 PHELAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5978
Practice Address - Country:US
Practice Address - Phone:409-866-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13225Medicare UPIN
601251Medicare ID - Type Unspecified