Provider Demographics
NPI:1518906668
Name:KUSTRA, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:KUSTRA
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 1:914 SKIPPACK PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1535
Mailing Address - Country:US
Mailing Address - Phone:215-540-0776
Mailing Address - Fax:215-540-9022
Practice Address - Street 1:914 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1535
Practice Address - Country:US
Practice Address - Phone:215-540-0776
Practice Address - Fax:215-540-9022
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003375L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000504030OtherHIGHMARK BLUE SHIELD
PA0109289000OtherBC PERSONAL CHOICE
PA1031454Medicaid
PA00001260825 02OtherUNITED HEALTHCARE
PA0843387OtherAETNA
PA001384519OtherHIGHMARK BLUE SHIELD
PA0843387OtherAETNA