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

Table of content: DR. ROBERT JOSEPH AVILA D.C., CCST, CCCN (NPI 1245248400)

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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