Provider Demographics
NPI:1912083247
Name:PAGE, ROBERT A
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 E MAIN STREET
Mailing Address - Street 2:STE A
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3960
Mailing Address - Country:US
Mailing Address - Phone:740-654-7541
Mailing Address - Fax:
Practice Address - Street 1:737 E MAIN STREET
Practice Address - Street 2:STE A
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3960
Practice Address - Country:US
Practice Address - Phone:740-654-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000117181OtherANTHEM
OH000000117181OtherANTHEM