Provider Demographics
NPI:1295923241
Name:ROSTAU, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ROSTAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 PARK BLVD
Mailing Address - Street 2:STE. C-102
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1931
Mailing Address - Country:US
Mailing Address - Phone:408-506-5174
Mailing Address - Fax:
Practice Address - Street 1:68-1768 AKAULA ST
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5507
Practice Address - Country:US
Practice Address - Phone:808-885-7719
Practice Address - Fax:808-885-4450
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor