MEDICARE: DR. ROBERT R WETZ D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC6130	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	603794	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1710032784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT R WETZ D.C.

Provider Business Mailing Address
First Line	:	1583 THOUSAND OAKS DR
Second Line	:	SUITE #127
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2300
Country	:	US
Telephone Number	:	210-545-2225
Fax Number	:	210-545-2254

Provider Business Practice Location Address
First Line	:	1583 THOUSAND OAKS DR
Second Line	:	SUITE #127
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2300
Country	:	US
Telephone Number	:	210-545-2225
Fax Number	:	210-545-2254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/09/2007

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