Provider Demographics
NPI:1639246630
Name:AMARA, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:AMARA
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 1:2750 S RIDGEWOOD AVE #C
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119
Mailing Address - Country:US
Mailing Address - Phone:386-767-2064
Mailing Address - Fax:386-756-5700
Practice Address - Street 1:2750 S RIDGEWOOD AVE #C
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119
Practice Address - Country:US
Practice Address - Phone:386-767-2064
Practice Address - Fax:386-756-5700
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88392Medicare ID - Type Unspecified