Provider Demographics
NPI:1700811684
Name:WALLS, ROBERT LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNN
Last Name:WALLS
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 1:11755 FM 730 N
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-5439
Mailing Address - Country:US
Mailing Address - Phone:817-333-9038
Mailing Address - Fax:817-622-7691
Practice Address - Street 1:621 N FM 1187
Practice Address - Street 2:STE A
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008
Practice Address - Country:US
Practice Address - Phone:817-333-7875
Practice Address - Fax:817-622-7691
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT-98301Medicare UPIN