Provider Demographics
NPI:1508032590
Name:PRUNI, ROBERT RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:PRUNI
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 1:3035 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1806
Mailing Address - Country:US
Mailing Address - Phone:404-831-1400
Mailing Address - Fax:
Practice Address - Street 1:3035 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE 7
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1806
Practice Address - Country:US
Practice Address - Phone:404-831-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008127111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician