Provider Demographics
NPI:1831256213
Name:SAMS, ROBERT BARRY (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BARRY
Last Name:SAMS
Suffix:
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0837
Mailing Address - Country:US
Mailing Address - Phone:208-888-7242
Mailing Address - Fax:208-888-7263
Practice Address - Street 1:1900 N LAKES PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6231
Practice Address - Country:US
Practice Address - Phone:208-888-7242
Practice Address - Fax:208-888-7263
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
38353OtherOLD BLUE SHIELD
000010009125OtherBLUE SHIELD
1671294Medicare ID - Type Unspecified
T44456Medicare UPIN