1245248400 NPI number — DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN

Table of content: DR. REBECCA WEATHERSBY DPT (NPI 1184960114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245248400 NPI number — DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVILA
Provider First Name:
ROBERT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., CCST, CCCN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245248400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3960 IVYWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81005-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-565-1276
Provider Business Mailing Address Fax Number:
719-565-2313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3960 IVYWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81005-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-565-1276
Provider Business Practice Location Address Fax Number:
719-565-2313
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN0400X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN1001X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NP0017X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0200X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0100X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 4867 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4867 . This is a "COLORADO LICENSE UPIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: COA106967 . This is a "MEDICARE PTAN DR AVILA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841603517 . This is a "TAX I.D." identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1245248400 . This is a "NPI DR AVILA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1821363557 . This is a "GROUP NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1295797413 . This is a "NPI DR WILSON" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: COA106966 . This is a "GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: COA107185 . This is a "MEDICARE PTAN DR. WILSON" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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