Provider Demographics
NPI:1801939251
Name:STREET, ROBERT E (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:STREET
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 1:711 E CAREFREE HWY
Mailing Address - Street 2:STE B-214
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0101
Mailing Address - Country:US
Mailing Address - Phone:623-582-4252
Mailing Address - Fax:623-582-4109
Practice Address - Street 1:711 E CAREFREE HWY
Practice Address - Street 2:STE B-214
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0101
Practice Address - Country:US
Practice Address - Phone:623-582-4252
Practice Address - Fax:623-582-4252
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3046111N00000X
MIRS002625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor