Provider Demographics
NPI:1336290501
Name:ERWIN, BOBBY CARROLL (DC)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:CARROLL
Last Name:ERWIN
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:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-0125
Mailing Address - Country:US
Mailing Address - Phone:972-838-2992
Mailing Address - Fax:972-838-2961
Practice Address - Street 1:1707 COOPER ST
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9542
Practice Address - Country:US
Practice Address - Phone:972-838-2992
Practice Address - Fax:972-838-2961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28694Medicare UPIN
603574Medicare ID - Type Unspecified