Provider Demographics
NPI:1871269209
Name:GUMP, ROBERT IV (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GUMP
Suffix:IV
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 1:13850 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-6205
Mailing Address - Country:US
Mailing Address - Phone:540-719-0821
Mailing Address - Fax:540-719-0978
Practice Address - Street 1:13850 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6205
Practice Address - Country:US
Practice Address - Phone:540-719-0821
Practice Address - Fax:540-719-0978
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor