Provider Demographics
NPI:1326018698
Name:REDMON, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:REDMON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:8555 AERO DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1744
Mailing Address - Country:US
Mailing Address - Phone:619-284-3321
Mailing Address - Fax:858-715-3909
Practice Address - Street 1:3019 POLK AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2609
Practice Address - Country:US
Practice Address - Phone:619-284-3321
Practice Address - Fax:619-280-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC14206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0142060Medicaid
CADC0142060Medicaid
CA953619523Medicare ID - Type Unspecified