Provider Demographics
NPI:1639406796
Name:DR. ROBIN R. WITT, D.C., P.A.
Entity Type:Organization
Organization Name:DR. ROBIN R. WITT, D.C., P.A.
Other - Org Name:DR. ROBIN R. WITT, D.C., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR / OWNER
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:DC
Authorized Official - Phone:817-283-4088
Mailing Address - Street 1:3004 S.H. 121
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-283-4088
Mailing Address - Fax:817-571-9756
Practice Address - Street 1:3004 HIGHWAY 121
Practice Address - Street 2:SUITE A
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4088
Practice Address - Country:US
Practice Address - Phone:817-283-4088
Practice Address - Fax:817-571-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty