Provider Demographics
NPI:1114947090
Name:DAHL, ROBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:DAHL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2717 N 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1813
Mailing Address - Country:US
Mailing Address - Phone:928-774-1463
Mailing Address - Fax:928-774-6039
Practice Address - Street 1:2717 N 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1813
Practice Address - Country:US
Practice Address - Phone:928-774-1463
Practice Address - Fax:928-774-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z82842Medicare PIN