Provider Demographics
NPI:1215149778
Name:RAMIREZ, ROBERT A (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:RAMIREZ
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-0305
Mailing Address - Country:US
Mailing Address - Phone:609-980-1190
Mailing Address - Fax:
Practice Address - Street 1:4814 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2108
Practice Address - Country:US
Practice Address - Phone:215-324-5853
Practice Address - Fax:215-324-6764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007402L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0768798000OtherBCBS INDIVIDUAL HMO NO
PA3137403OtherAETNA HMO PROVIDER NO
PA5785730OtherAETNA PPO PROVIDER NO
PA3137403OtherAETNA HMO PROVIDER NO