Provider Demographics
NPI:1912414285
Name:LIGON, ROBERT LOREN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOREN
Last Name:LIGON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 FOXGLOVE CIR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-4506
Mailing Address - Country:US
Mailing Address - Phone:330-696-3385
Mailing Address - Fax:
Practice Address - Street 1:3250 W MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3319
Practice Address - Country:US
Practice Address - Phone:330-696-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
623462800OtherU.S. DEP. OF LABOR - OFFICE OF WORKERS COMPENSAITON
623462800OtherU.S. DEP. OF LABOR - OFFICE OF WORKERS COMPENSAITON