Provider Demographics
NPI:1639340110
Name:ROBERT J. COOLBAUGH, DC, DBA LUBBOCK ACCIDENT AND INJURY REHAB
Entity Type:Organization
Organization Name:ROBERT J. COOLBAUGH, DC, DBA LUBBOCK ACCIDENT AND INJURY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOLBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-780-1258
Mailing Address - Street 1:2318 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2502
Mailing Address - Country:US
Mailing Address - Phone:806-780-1258
Mailing Address - Fax:
Practice Address - Street 1:2318 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2502
Practice Address - Country:US
Practice Address - Phone:806-780-1258
Practice Address - Fax:806-780-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF008104261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605947OtherBLUE CROSS BLUE SHIELD