Provider Demographics
NPI:1700078995
Name:COBURN, ROBERT LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:COBURN
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 1:211 N COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2518
Mailing Address - Country:US
Mailing Address - Phone:979-345-3181
Mailing Address - Fax:979-345-1473
Practice Address - Street 1:211 N COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2518
Practice Address - Country:US
Practice Address - Phone:979-345-3181
Practice Address - Fax:979-345-1473
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12712Medicare UPIN
TX8D5270Medicare PIN