Provider Demographics
NPI:1598840985
Name:LONDON, ROBERT GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:LONDON
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 1:2532 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5722
Mailing Address - Country:US
Mailing Address - Phone:954-977-8889
Mailing Address - Fax:954-977-4244
Practice Address - Street 1:2532 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5722
Practice Address - Country:US
Practice Address - Phone:954-977-8889
Practice Address - Fax:954-977-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor