Provider Demographics
NPI:1417162934
Name:ROBIN R. WITT
Entity Type:Organization
Organization Name:ROBIN R. WITT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:817-283-4088
Mailing Address - Street 1:1717 ARTHURS CIR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3421
Mailing Address - Country:US
Mailing Address - Phone:817-283-4088
Mailing Address - Fax:817-571-9756
Practice Address - Street 1:3004 S.H. 121 SUITE A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:73021
Practice Address - Country:US
Practice Address - Phone:817-283-4088
Practice Address - Fax:817-971-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4861111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER
TX=========OtherTAX ID NUMBER
TXU13819Medicare UPIN