Provider Demographics
NPI:1083654354
Name:BIRK, ROBERT LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:BIRK
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 1:3411 MCNIEL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1500
Mailing Address - Country:US
Mailing Address - Phone:940-228-4848
Mailing Address - Fax:940-692-5398
Practice Address - Street 1:3411 MCNIEL AVE STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1500
Practice Address - Country:US
Practice Address - Phone:940-228-4848
Practice Address - Fax:940-692-5398
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC-7261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046455402Medicaid
TX8F5940OtherBLUECROSS BLUESHIELD #
TXP00192167OtherRAILROAD MC PIN
TX8A2079Medicare ID - Type Unspecified
TX8F5940OtherBLUECROSS BLUESHIELD #