Provider Demographics
NPI:1629444369
Name:THEIS, ROBIN K (LAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:K
Last Name:THEIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 W OAKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2410
Mailing Address - Country:US
Mailing Address - Phone:414-416-9755
Mailing Address - Fax:
Practice Address - Street 1:13065 W MCDOWELL RD
Practice Address - Street 2:SUITE B111
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6439
Practice Address - Country:US
Practice Address - Phone:623-777-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist