Provider Demographics
NPI:1275997306
Name:ROBITAILLE, ANDRE JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:JAMES
Last Name:ROBITAILLE
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 1:450 S ABEL ST
Mailing Address - Street 2:#360245
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5211
Mailing Address - Country:US
Mailing Address - Phone:508-980-9164
Mailing Address - Fax:
Practice Address - Street 1:2724 ABORN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1204
Practice Address - Country:US
Practice Address - Phone:408-528-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor