Provider Demographics
NPI:1851725717
Name:REAM, ROBERT GERALD III (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERALD
Last Name:REAM
Suffix:III
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 1:144 INDIAN RDG
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7265
Mailing Address - Country:US
Mailing Address - Phone:219-575-8873
Mailing Address - Fax:
Practice Address - Street 1:1496 POPE CT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-5302
Practice Address - Country:US
Practice Address - Phone:219-926-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002732A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor