Provider Demographics
NPI:1477096196
Name:GARCIA, ROBERT JAMES (ATC, LAT, DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT JAMES
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:ATC, LAT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-2113
Mailing Address - Country:US
Mailing Address - Phone:805-801-3834
Mailing Address - Fax:
Practice Address - Street 1:2255 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6508
Practice Address - Country:US
Practice Address - Phone:310-322-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36054111N00000X
KS24-01067390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program