Provider Demographics
NPI:1689761496
Name:HOFFMANN, ROBERT CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:HOFFMANN
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 1:2330 CROSSTOWN BLVD NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4410
Mailing Address - Country:US
Mailing Address - Phone:763-434-5714
Mailing Address - Fax:763-434-3570
Practice Address - Street 1:2330 CROSSTOWN BLVD NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-4410
Practice Address - Country:US
Practice Address - Phone:763-434-5714
Practice Address - Fax:763-434-3570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349298200Medicaid
MN64995HOOtherBLUE CROSS ID NUMBER
MNT39729Medicare UPIN
MN349298200Medicaid