Provider Demographics
NPI:1376664847
Name:URBANOVSKY, ROBERT LANCE (D C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LANCE
Last Name:URBANOVSKY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-0384
Mailing Address - Country:US
Mailing Address - Phone:254-675-3850
Mailing Address - Fax:254-675-3850
Practice Address - Street 1:202 N AVE G
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-0384
Practice Address - Country:US
Practice Address - Phone:254-675-3850
Practice Address - Fax:254-675-3850
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609245OtherBCBS
TX609245OtherBCBS
TXU74629Medicare UPIN