Provider Demographics
NPI:1811964414
Name:VILLE, ROBERT A (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VILLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 S COURTENAY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4977
Mailing Address - Country:US
Mailing Address - Phone:321-394-2660
Mailing Address - Fax:321-394-2669
Practice Address - Street 1:650 S COURTENAY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4977
Practice Address - Country:US
Practice Address - Phone:321-394-2660
Practice Address - Fax:321-394-2669
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005861111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22256XMedicare PIN
FLT94036Medicare UPIN