Provider Demographics
NPI:1730185281
Name:KUSTIN, ROBERT M (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:KUSTIN
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 1:2240 SW 70TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7112
Mailing Address - Country:US
Mailing Address - Phone:954-430-8000
Mailing Address - Fax:954-212-0150
Practice Address - Street 1:2240 SW 70TH AVE STE D
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7112
Practice Address - Country:US
Practice Address - Phone:954-430-8000
Practice Address - Fax:954-212-0150
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55631ZMedicare PIN
U72945Medicare UPIN