Provider Demographics
NPI:1972684314
Name:BATES, ROBERT C (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BATES
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 1:1218 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BCH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4718
Mailing Address - Country:US
Mailing Address - Phone:310-545-4188
Mailing Address - Fax:310-545-4789
Practice Address - Street 1:1218 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4718
Practice Address - Country:US
Practice Address - Phone:310-545-4188
Practice Address - Fax:310-545-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17958111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17958Medicare ID - Type UnspecifiedCHIROPRACTOR LICENSE