Provider Demographics
NPI:1801212527
Name:BURGETT, ROBERT O (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:BURGETT
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 1:107 RANCH ROAD 620 S
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3942
Mailing Address - Country:US
Mailing Address - Phone:515-371-8240
Mailing Address - Fax:
Practice Address - Street 1:107 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-3942
Practice Address - Country:US
Practice Address - Phone:515-371-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor