Provider Demographics
NPI:1831269570
Name:WELCH, ROBERT DAVID (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:WELCH
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 1:1628 E BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2515
Mailing Address - Country:US
Mailing Address - Phone:602-230-9292
Mailing Address - Fax:602-230-2319
Practice Address - Street 1:1628 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2515
Practice Address - Country:US
Practice Address - Phone:602-230-9292
Practice Address - Fax:602-230-2319
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor