Provider Demographics
NPI:1871641639
Name:CAVALLARO, ROBERT (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CAVALLARO
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 1:459 JACKSON ROAD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004
Mailing Address - Country:US
Mailing Address - Phone:856-768-4220
Mailing Address - Fax:856-768-7806
Practice Address - Street 1:459 JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004
Practice Address - Country:US
Practice Address - Phone:856-768-4220
Practice Address - Fax:856-768-7806
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0073080000OtherAMERIHEALTH
546982OtherAETNA
035742Medicare ID - Type Unspecified
035742Medicare UPIN