Provider Demographics
NPI:1477615235
Name:MASON, ROBERT CHRISTOPHER (DC, DACAN QME)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:MASON
Suffix:
Gender:M
Credentials:DC, DACAN QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0679
Mailing Address - Country:US
Mailing Address - Phone:619-589-7869
Mailing Address - Fax:619-589-7886
Practice Address - Street 1:5181 BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0679
Practice Address - Country:US
Practice Address - Phone:619-589-7869
Practice Address - Fax:619-589-7886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18530111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18702Medicare UPIN
CAT18702Medicare ID - Type Unspecified