Provider Demographics
NPI:1700921459
Name:TATUM, ROBERT C (DC, DACBR)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:TATUM
Suffix:
Gender:M
Credentials:DC, DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 LAMPHERE CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-3426
Mailing Address - Country:US
Mailing Address - Phone:563-388-0029
Mailing Address - Fax:
Practice Address - Street 1:4031 LAMPHERE CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3426
Practice Address - Country:US
Practice Address - Phone:563-388-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05536111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology