Provider Demographics
NPI:1942298831
Name:WATKINS, ROBERT ERNEST JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERNEST
Last Name:WATKINS
Suffix:JR
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 1:6430 PLANTATION PARK CT STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4815
Mailing Address - Country:US
Mailing Address - Phone:239-590-9555
Mailing Address - Fax:866-254-8158
Practice Address - Street 1:6430 PLANTATION PARK CT STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4815
Practice Address - Country:US
Practice Address - Phone:239-590-9555
Practice Address - Fax:866-254-8158
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
55775OtherBCBS #
FL3811751-00Medicaid
350044658OtherRR MEDICARE
FL3811751-01Medicaid
350044658OtherUHC RR MEDICARE
FLE0872AMedicare PIN
350044658OtherRR MEDICARE
FL3811751-01Medicaid