Provider Demographics
NPI:1811609688
Name:ULLOA, ROBERTO JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:ULLOA
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 1:700 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9593
Mailing Address - Country:US
Mailing Address - Phone:563-289-3242
Mailing Address - Fax:
Practice Address - Street 1:515 18TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-2037
Practice Address - Country:US
Practice Address - Phone:619-410-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor