Provider Demographics
NPI:1740276336
Name:MIDDLETON, ROBERT E JR (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MIDDLETON
Suffix:JR
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 1:212 E MAIN ST
Mailing Address - Street 2:PO BOX 18
Mailing Address - City:ARCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61910-1416
Mailing Address - Country:US
Mailing Address - Phone:217-268-4743
Mailing Address - Fax:217-268-4743
Practice Address - Street 1:212 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1416
Practice Address - Country:US
Practice Address - Phone:217-268-4743
Practice Address - Fax:217-268-4743
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006866111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36003Medicare UPIN
IL285182Medicare ID - Type Unspecified