Provider Demographics
NPI:1649295700
Name:EDMINSTON, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:EDMINSTON
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 1:22 MERAMEC VALLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-2112
Mailing Address - Country:US
Mailing Address - Phone:636-225-3030
Mailing Address - Fax:636-225-3516
Practice Address - Street 1:22 MERAMEC VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-2112
Practice Address - Country:US
Practice Address - Phone:636-225-3030
Practice Address - Fax:636-225-3516
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE005206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85089Medicare UPIN