Provider Demographics
NPI:1558631812
Name:ROBERT A. CLEMENTS, D.C., P.C.
Entity Type:Organization
Organization Name:ROBERT A. CLEMENTS, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIRPRATIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-452-1330
Mailing Address - Street 1:925 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5598
Mailing Address - Country:US
Mailing Address - Phone:765-452-1313
Mailing Address - Fax:
Practice Address - Street 1:925 S UNION ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5598
Practice Address - Country:US
Practice Address - Phone:765-452-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN361950Medicare PIN