Provider Demographics
NPI:1346349412
Name:GOTTESMAN, ROBERT LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:GOTTESMAN
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 1:1 NE 23RD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5247
Mailing Address - Country:US
Mailing Address - Phone:954-785-6000
Mailing Address - Fax:954-785-6005
Practice Address - Street 1:1 NE 23RD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5247
Practice Address - Country:US
Practice Address - Phone:954-785-6000
Practice Address - Fax:954-785-6005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00004926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85480Medicare UPIN