Provider Demographics
NPI:1265522379
Name:WHEELER, ROBERT KENNETH II (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KENNETH
Last Name:WHEELER
Suffix:II
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 1:4050 LAKE OTIS PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5220
Mailing Address - Country:US
Mailing Address - Phone:907-770-6325
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5220
Practice Address - Country:US
Practice Address - Phone:907-770-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHO341Medicaid
AKV08661Medicare UPIN
AKCHO341Medicaid