Provider Demographics
NPI:1659458057
Name:SPERDUTI, ROBERT S (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:SPERDUTI
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 1:2220 E FRUIT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4459
Mailing Address - Country:US
Mailing Address - Phone:714-542-3791
Mailing Address - Fax:
Practice Address - Street 1:2220 E FRUIT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4459
Practice Address - Country:US
Practice Address - Phone:714-542-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 11381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11381Medicare ID - Type Unspecified