Provider Demographics
NPI:1861771255
Name:INNIS, ROBERT MATHEW (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MATHEW
Last Name:INNIS
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:9929 ALBEMARLE RD
Mailing Address - Street 2:STE 3B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3371
Mailing Address - Country:US
Mailing Address - Phone:704-545-7410
Mailing Address - Fax:980-939-6336
Practice Address - Street 1:9929 ALBEMARLE RD
Practice Address - Street 2:STE 3B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3371
Practice Address - Country:US
Practice Address - Phone:704-545-7410
Practice Address - Fax:980-939-6336
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor