Provider Demographics
NPI:1619990256
Name:DEMETREE, ROBERT ALAN (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:DEMETREE
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 1:797 N STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7233
Mailing Address - Country:US
Mailing Address - Phone:407-862-7272
Mailing Address - Fax:407-682-6444
Practice Address - Street 1:797 N STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7233
Practice Address - Country:US
Practice Address - Phone:407-862-7272
Practice Address - Fax:407-682-6444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7051Medicare ID - Type Unspecified
FLU70438Medicare UPIN