Provider Demographics
NPI:1316944895
Name:HALLETT, ROBERT B (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:HALLETT
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 1:3263 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1605
Mailing Address - Country:US
Mailing Address - Phone:248-674-1900
Mailing Address - Fax:248-674-0711
Practice Address - Street 1:3263 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1605
Practice Address - Country:US
Practice Address - Phone:248-674-1900
Practice Address - Fax:248-674-0711
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH005065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3328523Medicaid
MI950F328260OtherBCBS
MIOM30800Medicare ID - Type Unspecified
MI3328523Medicaid