Provider Demographics
NPI:1487241030
Name:BRIDGES, ROBERT LANCE (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LANCE
Last Name:BRIDGES
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 1:1605 COUNTRY ROAD 220 STE 165
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-712-3548
Mailing Address - Fax:904-712-3813
Practice Address - Street 1:1605 COUNTY ROAD 220 STE 165
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4910
Practice Address - Country:US
Practice Address - Phone:904-712-3548
Practice Address - Fax:904-712-3813
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010466111N00000X
FLCH13563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor