Provider Demographics
NPI:1336191790
Name:DAVIS, ROBERT ELLERSLIE III (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLERSLIE
Last Name:DAVIS
Suffix:III
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 1:6700 WINKLER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7235
Mailing Address - Country:US
Mailing Address - Phone:239-482-8686
Mailing Address - Fax:239-482-8681
Practice Address - Street 1:6700 WINKLER RD STE 3
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7235
Practice Address - Country:US
Practice Address - Phone:239-482-8686
Practice Address - Fax:239-482-8681
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69003OtherBCBS
FLU72385Medicare UPIN
FLU6068AMedicare ID - Type Unspecified