Provider Demographics
NPI:1528191921
Name:WINES, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WINES
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 1:550 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2242
Mailing Address - Country:US
Mailing Address - Phone:951-845-1830
Mailing Address - Fax:
Practice Address - Street 1:550 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2242
Practice Address - Country:US
Practice Address - Phone:951-845-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3199247OtherTAX ID NUMBER