Provider Demographics
NPI:1497715569
Name:FEDORE, ROBERT NATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NATHAN
Last Name:FEDORE
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 1:3758 LAUREL TRACE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-1516
Mailing Address - Country:US
Mailing Address - Phone:724-396-1585
Mailing Address - Fax:
Practice Address - Street 1:2339 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4733
Practice Address - Country:US
Practice Address - Phone:850-900-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8901111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFE4184551Medicare PIN
OHVO5252Medicare UPIN