Individual
DR. ROBERT JOSEPH AVILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., CCST, CCCN
Contact information
Practice address
3960 IVYWOOD LN, PUEBLO, CO 81005-2567
(719) 565-1276
(719) 565-2313
Mailing address
3960 IVYWOOD LN, PUEBLO, CO 81005-2567
(719) 565-1276
(719) 565-2313
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
111N00000X
Chiropractor
Primary
4867
CO
111NN0400X
Neurology Chiropractor
4867
CO
111NN1001X
Nutrition Chiropractor
4867
CO
111NP0017X
Pediatric Chiropractor
4867
CO
111NR0200X
Radiology Chiropractor
4867
CO
111NR0400X
Rehabilitation Chiropractor
4867
CO
111NS0005X
Sports Physician Chiropractor
4867
CO
111NX0100X
Occupational Health Chiropractor
4867
CO
111NX0800X
Orthopedic Chiropractor
4867
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245248400
NPI DR AVILA
CO
01
—
1295797413
NPI DR WILSON
CO
01
—
1821363557
GROUP NPI
CO
01
—
4867
COLORADO LICENSE UPIN
CO
01
—
841603517
TAX I.D.
CO
01
—
COA106966
GROUP PTAN
—
01
—
COA106967
MEDICARE PTAN DR AVILA
CO
01
—
COA107185
MEDICARE PTAN DR. WILSON
CO
Enumeration date
08/04/2006
Last updated
03/17/2020
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