Provider Demographics
NPI:1437251006
Name:ROBINSON, GERALD THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:THOMAS
Last Name:ROBINSON
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 1:10 EDINBURG CT
Mailing Address - Street 2:STE. 1
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1511
Mailing Address - Country:US
Mailing Address - Phone:314-395-9595
Mailing Address - Fax:
Practice Address - Street 1:10 EDINBURG CT
Practice Address - Street 2:STE. 1
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1511
Practice Address - Country:US
Practice Address - Phone:314-395-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43297Medicare UPIN