Provider Demographics
NPI:1548351505
Name:VANBREEMEN, ROBERT BUCKLEY (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BUCKLEY
Last Name:VANBREEMEN
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 1:2107 S BURNSIDE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4665
Mailing Address - Country:US
Mailing Address - Phone:225-647-8712
Mailing Address - Fax:225-647-8718
Practice Address - Street 1:2107 S BURNSIDE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4665
Practice Address - Country:US
Practice Address - Phone:225-647-8712
Practice Address - Fax:225-647-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT83839Medicare UPIN
LA5D891Medicare ID - Type Unspecified