Provider Demographics
NPI:1467510610
Name:BERUBE, ROBERT BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADFORD
Last Name:BERUBE
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 1:3308 FOREST EDGE CT
Mailing Address - Street 2:APT C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-8778
Mailing Address - Country:US
Mailing Address - Phone:804-864-0682
Mailing Address - Fax:804-377-3007
Practice Address - Street 1:8600 QUIOCCASIN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5514
Practice Address - Country:US
Practice Address - Phone:804-377-3005
Practice Address - Fax:804-377-3007
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA279464Medicare UPIN
VA00V650Y70Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER