Provider Demographics
NPI:1457489098
Name:STONE, ROBERT LEONARD III (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEONARD
Last Name:STONE
Suffix:III
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3901
Mailing Address - Country:US
Mailing Address - Phone:831-638-0211
Mailing Address - Fax:831-638-0209
Practice Address - Street 1:211 5TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3901
Practice Address - Country:US
Practice Address - Phone:831-638-0211
Practice Address - Fax:831-638-0209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24226111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU61034Medicare UPIN
CADC0242261Medicare ID - Type Unspecified