Provider Demographics
NPI:1689013187
Name:DE STEFANO, ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DE STEFANO
Suffix:JR
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 1:1532 OAKFIELD DR
Mailing Address - Street 2:STE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-0829
Mailing Address - Country:US
Mailing Address - Phone:813-381-3852
Mailing Address - Fax:813-381-3873
Practice Address - Street 1:1532 OAKFIELD DR
Practice Address - Street 2:STE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0829
Practice Address - Country:US
Practice Address - Phone:813-381-3852
Practice Address - Fax:813-381-3873
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor