Provider Demographics
NPI:1114586799
Name:TONTI, ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TONTI
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 1:9117 TRAIL BLAZER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3119
Mailing Address - Country:US
Mailing Address - Phone:817-946-3413
Mailing Address - Fax:
Practice Address - Street 1:3017 FM 718
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:TX
Practice Address - Zip Code:76071-4001
Practice Address - Country:US
Practice Address - Phone:817-956-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor