Provider Demographics
NPI:1891706651
Name:WAIKEL, ROBERT EUGENE IV (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:WAIKEL
Suffix:IV
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:APRIL
Other - Middle Name:NICOLE
Other - Last Name:BEARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:6788 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4700
Mailing Address - Country:US
Mailing Address - Phone:770-907-0000
Mailing Address - Fax:770-997-6098
Practice Address - Street 1:6788 CHURCH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4700
Practice Address - Country:US
Practice Address - Phone:770-907-0000
Practice Address - Fax:770-997-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCCTMedicare ID - Type UnspecifiedCHIROPRACTIC