Provider Demographics
NPI:1386835825
Name:ABRAHAMSON, ROBERT (LICAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:ABRAHAMSON
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 W HWY 89A STE 3D
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5577
Mailing Address - Country:US
Mailing Address - Phone:928-204-0595
Mailing Address - Fax:
Practice Address - Street 1:1785 W HWY 89A STE 3D
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5577
Practice Address - Country:US
Practice Address - Phone:928-204-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0170171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist