Provider Demographics
NPI:1598941163
Name:ROBERT W. FUELLING, DC, PC
Entity Type:Organization
Organization Name:ROBERT W. FUELLING, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FUELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-233-9717
Mailing Address - Street 1:1425 W 5TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2900
Mailing Address - Country:US
Mailing Address - Phone:319-233-9717
Mailing Address - Fax:319-233-7628
Practice Address - Street 1:1425 W 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2900
Practice Address - Country:US
Practice Address - Phone:319-233-9717
Practice Address - Fax:319-233-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty