Provider Demographics
NPI:1770548943
Name:SCHELLENBERG, ROBERT L JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:SCHELLENBERG
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 1:1200 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3708
Mailing Address - Country:US
Mailing Address - Phone:772-288-2008
Mailing Address - Fax:772-288-3256
Practice Address - Street 1:1200 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3708
Practice Address - Country:US
Practice Address - Phone:772-288-2008
Practice Address - Fax:772-288-3256
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381694000Medicaid
FL70098OtherBLUE CROSS BLUE SHIELD
FL494594Medicare UPIN
FL381694000Medicaid