Provider Demographics
NPI:1831318641
Name:KLINGENSMITH, ROBERT DUANE (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DUANE
Last Name:KLINGENSMITH
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675
Mailing Address - Country:US
Mailing Address - Phone:336-372-2005
Mailing Address - Fax:336-372-2005
Practice Address - Street 1:771 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675
Practice Address - Country:US
Practice Address - Phone:336-372-2005
Practice Address - Fax:336-372-2005
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890831EMedicaid
T64571Medicare UPIN
NC244564AMedicare ID - Type Unspecified