Provider Demographics
NPI:1376539270
Name:EBERT, ROBERT E (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:EBERT
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 1:1445 ANSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3430
Mailing Address - Country:US
Mailing Address - Phone:319-232-9436
Mailing Address - Fax:319-232-2342
Practice Address - Street 1:1445 ANSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3430
Practice Address - Country:US
Practice Address - Phone:319-232-9436
Practice Address - Fax:319-232-2342
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419382Medicaid
T00287Medicare UPIN
IA11344Medicare ID - Type Unspecified