Provider Demographics
NPI:1992728182
Name:AMMON, ROBERT JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:AMMON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:R.J.
Other - Middle Name:
Other - Last Name:AMMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4200 EAST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4945
Mailing Address - Country:US
Mailing Address - Phone:925-371-7300
Mailing Address - Fax:
Practice Address - Street 1:4200 EAST AVE STE 102
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4945
Practice Address - Country:US
Practice Address - Phone:925-371-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06070Medicare UPIN