Provider Demographics
NPI:1659346849
Name:BARITZ, ROBERT W (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:BARITZ
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 1:450 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-583-2565
Mailing Address - Fax:508-580-2477
Practice Address - Street 1:450 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-2565
Practice Address - Fax:508-580-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1601415Medicaid
T58328Medicare UPIN
MA1601415Medicaid