Provider Demographics
NPI:1962575126
Name:PIZZIMENTI, ROBERT (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PIZZIMENTI
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 1:18700 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1965
Mailing Address - Country:US
Mailing Address - Phone:313-366-2247
Mailing Address - Fax:313-893-6802
Practice Address - Street 1:18700 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1965
Practice Address - Country:US
Practice Address - Phone:313-366-2247
Practice Address - Fax:313-893-6802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP006551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU38281Medicare UPIN
MI0F35292Medicare ID - Type Unspecified