Provider Demographics
NPI:1518063593
Name:POMAHAC, ROBERT R (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:POMAHAC
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 1:6200 WILSHIRE BLVD STE 805
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5809
Mailing Address - Country:US
Mailing Address - Phone:323-938-0511
Mailing Address - Fax:866-277-7532
Practice Address - Street 1:6200 WILSHIRE BLVD STE 805
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5809
Practice Address - Country:US
Practice Address - Phone:323-938-0511
Practice Address - Fax:866-277-7532
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0283240OtherBLUE SHIELD
CAU91319Medicare UPIN
CADC28324Medicare ID - Type UnspecifiedMEDICARE