Provider Demographics
NPI:1437117967
Name:HAWTHORNE, ROBERT J (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:HAWTHORNE
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 1:4001 SWIFT RD
Mailing Address - Street 2:STE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6578
Mailing Address - Country:US
Mailing Address - Phone:941-383-7262
Mailing Address - Fax:941-927-7262
Practice Address - Street 1:4001 SWIFT RD
Practice Address - Street 2:STE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6578
Practice Address - Country:US
Practice Address - Phone:941-383-7262
Practice Address - Fax:941-927-7262
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHC0004148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380723100Medicaid
FL22630AMedicare PIN
FL380723100Medicaid