Provider Demographics
NPI:1477634988
Name:BLUE, ROBERT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BLUE
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:W5669 CTY RD KK
Mailing Address - Street 2:SUITE D
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-9468
Mailing Address - Country:US
Mailing Address - Phone:920-731-8002
Mailing Address - Fax:920-731-8006
Practice Address - Street 1:W5669 CTY RD KK
Practice Address - Street 2:SUITE D
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-9468
Practice Address - Country:US
Practice Address - Phone:920-731-8002
Practice Address - Fax:920-731-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2991-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000070818Medicare ID - Type Unspecified
WIU44065Medicare UPIN