Provider Demographics
NPI:1336796820
Name:WERTZ, ROBERT LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:WERTZ
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 1:171 GRAND STATION CIR APT 1A
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7217
Mailing Address - Country:US
Mailing Address - Phone:847-809-6740
Mailing Address - Fax:
Practice Address - Street 1:171 GRAND STATION CIR APT 1A
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7217
Practice Address - Country:US
Practice Address - Phone:847-809-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002809A111N00000X
INCH7570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor