Provider Demographics
NPI:1508896408
Name:CANAL, ROBERT ELLIOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:CANAL
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 1:1706 PINE GAP DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2359
Mailing Address - Country:US
Mailing Address - Phone:713-894-3623
Mailing Address - Fax:281-919-1466
Practice Address - Street 1:1706 PINE GAP DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2359
Practice Address - Country:US
Practice Address - Phone:713-894-3623
Practice Address - Fax:281-919-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S1120OtherBCBS NUMBER
TX612401Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXU50289Medicare UPIN