Provider Demographics
NPI:1215069893
Name:UPCHURCH, ROBERT CLAUD III (ND)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLAUD
Last Name:UPCHURCH
Suffix:III
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N HASSAYAMPA DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4105
Mailing Address - Country:US
Mailing Address - Phone:928-778-7551
Mailing Address - Fax:
Practice Address - Street 1:810 W GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3624
Practice Address - Country:US
Practice Address - Phone:928-445-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ386175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath