Provider Demographics
NPI:1811010051
Name:ROBERT R. FACCA D.C.P.C.
Entity Type:Organization
Organization Name:ROBERT R. FACCA D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROSSIT
Authorized Official - Last Name:FACCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-545-1550
Mailing Address - Street 1:2715 W WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3700
Mailing Address - Country:US
Mailing Address - Phone:248-545-1550
Mailing Address - Fax:248-545-2327
Practice Address - Street 1:2715 W WEBSTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3700
Practice Address - Country:US
Practice Address - Phone:248-545-1550
Practice Address - Fax:248-545-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35217Medicare PIN