Provider Demographics
NPI:1649276213
Name:CANTU, ROBERTO OMAR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:OMAR
Last Name:CANTU
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 1:3027 MARINA BAY DR
Mailing Address - Street 2:203
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2888
Mailing Address - Country:US
Mailing Address - Phone:832-864-3769
Mailing Address - Fax:858-509-3993
Practice Address - Street 1:3027 MARINA BAY DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2729
Practice Address - Country:US
Practice Address - Phone:832-864-3769
Practice Address - Fax:858-509-3993
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P1440OtherBLUE CROSS BLUE SHIELD
TX8D2349Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXV03897Medicare UPIN