Provider Demographics
NPI:1386714707
Name:DEVINE, ROBERT PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:DEVINE
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 1:211 HILLSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1623
Mailing Address - Country:US
Mailing Address - Phone:618-656-5300
Mailing Address - Fax:618-692-0200
Practice Address - Street 1:211 HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1623
Practice Address - Country:US
Practice Address - Phone:618-656-5300
Practice Address - Fax:618-692-0200
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL44-00227OtherUNITED HEALTHCARE
IL44-00227OtherUNITED HEALTHCARE
IL669190Medicare ID - Type Unspecified