Provider Demographics
NPI:1134224330
Name:ACKERMAN, ROBERT M (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:ACKERMAN
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 1:5409 BOCA RATON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3006
Mailing Address - Country:US
Mailing Address - Phone:214-265-5660
Mailing Address - Fax:
Practice Address - Street 1:2050 W SPRING CREEK PKWY
Practice Address - Street 2:#208
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4224
Practice Address - Country:US
Practice Address - Phone:469-467-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10706111N00000X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV04533Medicare UPIN