Provider Demographics
NPI:1023119443
Name:CHESNUTT, ROBERT GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLENN
Last Name:CHESNUTT
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 1:5931 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2572
Mailing Address - Country:US
Mailing Address - Phone:334-271-0800
Mailing Address - Fax:334-244-2073
Practice Address - Street 1:5931 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2572
Practice Address - Country:US
Practice Address - Phone:334-271-0800
Practice Address - Fax:334-244-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL73579OtherBC/BC OF AL PROVIDER #
ALT68366Medicare UPIN