Provider Demographics
NPI:1699823070
Name:AMIS, ROBERT BOYD JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BOYD
Last Name:AMIS
Suffix:JR
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 1:611 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9543
Mailing Address - Country:US
Mailing Address - Phone:574-825-8118
Mailing Address - Fax:574-822-1169
Practice Address - Street 1:611 WAYNE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9543
Practice Address - Country:US
Practice Address - Phone:574-825-8118
Practice Address - Fax:574-822-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001879A111N00000X
MI2301007973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN181290AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER