Provider Demographics
NPI:1992889224
Name:STAULO, ROBERT NICHOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NICHOLAS
Last Name:STAULO
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 1:52 WAVEWAY AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1235
Mailing Address - Country:US
Mailing Address - Phone:617-336-3223
Mailing Address - Fax:
Practice Address - Street 1:52 WAVEWAY AVE
Practice Address - Street 2:APT 1
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1235
Practice Address - Country:US
Practice Address - Phone:617-336-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT79855Medicare UPIN
MAY35942Medicare ID - Type Unspecified