Provider Demographics
NPI:1356422620
Name:PRATT, ROBERT A (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:PRATT
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 1:3023 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2316
Mailing Address - Country:US
Mailing Address - Phone:719-564-0461
Mailing Address - Fax:719-566-8600
Practice Address - Street 1:3023 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2316
Practice Address - Country:US
Practice Address - Phone:719-564-0461
Practice Address - Fax:719-566-8600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC44453Medicare ID - Type Unspecified