Provider Demographics
NPI:1770888273
Name:CARUSO, ROBERT GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERARD
Last Name:CARUSO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:CARUSO
Other - Last Name:CARUSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3435 CAMINO DEL RIO S STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3911
Mailing Address - Country:US
Mailing Address - Phone:619-808-4550
Mailing Address - Fax:619-329-4390
Practice Address - Street 1:3435 CAMINO DEL RIO S STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3911
Practice Address - Country:US
Practice Address - Phone:808-292-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2023-09-11
Deactivation Date:2022-12-07
Deactivation Code:
Reactivation Date:2023-03-30
Provider Licenses
StateLicense IDTaxonomies
CADC-29507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor