Provider Demographics
NPI:1235268681
Name:AFFOLTER, ROBERT CLYDE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLYDE
Last Name:AFFOLTER
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 1:114 W MAGNOLIA ST STE 108
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4354
Mailing Address - Country:US
Mailing Address - Phone:360-733-1660
Mailing Address - Fax:360-733-1182
Practice Address - Street 1:114 W MAGNOLIA ST STE 108
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4354
Practice Address - Country:US
Practice Address - Phone:360-733-1660
Practice Address - Fax:360-733-1182
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0331322OtherWASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES
WAG8914972Medicare PIN
WAG8865476Medicare PIN
WAG8854851Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER