Provider Demographics
NPI:1205171717
Name:WEST, ROBERT M (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WEST
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 1:1423 CREEKMERE DR
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-5227
Mailing Address - Country:US
Mailing Address - Phone:806-655-3534
Mailing Address - Fax:
Practice Address - Street 1:1423 CREEKMERE DR
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-5227
Practice Address - Country:US
Practice Address - Phone:806-655-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T16556Medicare UPIN
600229Medicare PIN