Provider Demographics
NPI:1568560142
Name:ROBERT L. COBURN, D.C.,P.C.
Entity Type:Organization
Organization Name:ROBERT L. COBURN, D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-345-3181
Mailing Address - Street 1:211 N COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2518
Mailing Address - Country:US
Mailing Address - Phone:979-345-3181
Mailing Address - Fax:979-345-1473
Practice Address - Street 1:211 N COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2518
Practice Address - Country:US
Practice Address - Phone:979-345-3181
Practice Address - Fax:979-345-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV05293Medicare UPIN
TX8F0133Medicare ID - Type Unspecified
TXT12712Medicare UPIN
TX8D5270Medicare ID - Type Unspecified