Provider Demographics
NPI:1760713002
Name:ROBERT SCHELLENBERG D.C., P.A.
Entity Type:Organization
Organization Name:ROBERT SCHELLENBERG D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHELLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-288-2008
Mailing Address - Street 1:1200 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3708
Mailing Address - Country:US
Mailing Address - Phone:772-288-2008
Mailing Address - Fax:772-288-3256
Practice Address - Street 1:1200 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3708
Practice Address - Country:US
Practice Address - Phone:772-288-2008
Practice Address - Fax:772-288-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381694000Medicaid
FL70098OtherBCBS
FLCZ159OtherMEDICARE ID
FL70098OtherMEDICARE PTAN
FLCZ159OtherMEDICARE ID