Provider Demographics
NPI:1326076092
Name:BEDFORD, ROBERT L (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BEDFORD
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 1:3020 E HEBRON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4457
Mailing Address - Country:US
Mailing Address - Phone:972-820-0425
Mailing Address - Fax:972-662-4411
Practice Address - Street 1:3020 E HEBRON PKWY
Practice Address - Street 2:STE 200
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4457
Practice Address - Country:US
Practice Address - Phone:972-820-0425
Practice Address - Fax:972-662-4411
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9141OtherCHIROPRACTIC LICENSE