Provider Demographics
NPI:1568443687
Name:JUSTUS, ROBERT G (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:JUSTUS
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 756
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-0756
Mailing Address - Country:US
Mailing Address - Phone:845-888-2222
Mailing Address - Fax:845-888-5554
Practice Address - Street 1:112 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:WURTSBORO
Practice Address - State:NY
Practice Address - Zip Code:12790
Practice Address - Country:US
Practice Address - Phone:845-888-2222
Practice Address - Fax:845-888-5554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004155-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52713Medicare UPIN
X23051Medicare ID - Type Unspecified