Provider Demographics
NPI:1295872463
Name:INDELICATO, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:INDELICATO
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 1:239 301 BLVD E
Mailing Address - Street 2:SUITE H
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4430
Mailing Address - Country:US
Mailing Address - Phone:941-746-2612
Mailing Address - Fax:941-746-2789
Practice Address - Street 1:239 301 BLVD E
Practice Address - Street 2:SUITE H
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4430
Practice Address - Country:US
Practice Address - Phone:941-746-2612
Practice Address - Fax:941-746-2789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8841111N00000X
NYX004843-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT53037Medicare UPIN
FLU3556Medicare ID - Type Unspecified