Provider Demographics
NPI:1891078275
Name:COLEMAN, ROBERT EDWARD JR (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:ND, LMT
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Other - Middle Name:
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Mailing Address - Street 1:4465 N OAKLAND AVE STE 200S
Mailing Address - Street 2:INTEGRATIVE HEALTH SERVICES
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1662
Mailing Address - Country:US
Mailing Address - Phone:414-906-0285
Mailing Address - Fax:414-906-0285
Practice Address - Street 1:4465 N OAKLAND AVE STE 200S
Practice Address - Street 2:INTEGRATIVE HEALTH SERVICES
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1662
Practice Address - Country:US
Practice Address - Phone:414-906-0285
Practice Address - Fax:414-906-0285
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAND-457175F00000X
WI10900-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist