Provider Demographics
NPI:1770581647
Name:FACCA, ROBERT ROSSIT (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROSSIT
Last Name:FACCA
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 W WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3700
Mailing Address - Country:US
Mailing Address - Phone:248-545-1550
Mailing Address - Fax:248-545-2327
Practice Address - Street 1:2715 W WEBSTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3700
Practice Address - Country:US
Practice Address - Phone:248-545-1550
Practice Address - Fax:248-545-2327
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2957979Medicaid
MIT33403Medicare UPIN
MI2957979Medicaid