Provider Demographics
NPI:1083756167
Name:DORN, ROBY CHRISTIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBY
Middle Name:CHRISTIAN
Last Name:DORN
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 1:1280 BROWN ST STE K-2
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2489
Mailing Address - Country:US
Mailing Address - Phone:262-203-9036
Mailing Address - Fax:262-203-9774
Practice Address - Street 1:1280 BROWN ST STE K-2
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2489
Practice Address - Country:US
Practice Address - Phone:262-203-9036
Practice Address - Fax:262-203-9774
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4053-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38958700Medicaid
WI$$$$$$$$$007OtherBCBS
WI$$$$$$$$$007OtherBCBS