Provider Demographics
NPI:1083729057
Name:FUELLING, ROBERT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:FUELLING
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 1:1425 W 5TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2900
Mailing Address - Country:US
Mailing Address - Phone:319-233-9717
Mailing Address - Fax:319-233-7628
Practice Address - Street 1:1425 W 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2900
Practice Address - Country:US
Practice Address - Phone:319-233-9717
Practice Address - Fax:319-233-7628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1170878Medicaid
IAU69581Medicare UPIN
IAI0474Medicare ID - Type Unspecified