Provider Demographics
NPI:1346300282
Name:ENSLEY, ROBERT DANA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANA
Last Name:ENSLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1313 TRAVIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4621
Mailing Address - Country:US
Mailing Address - Phone:707-426-3655
Mailing Address - Fax:707-426-3656
Practice Address - Street 1:1313 TRAVIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4621
Practice Address - Country:US
Practice Address - Phone:707-426-3655
Practice Address - Fax:707-426-3656
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12399OtherLICENSE #
CA12399OtherLICENSE #