Provider Demographics
NPI:1871521336
Name:CARPENTER, ROBERT I (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:CARPENTER
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 1:10731 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2555
Mailing Address - Country:US
Mailing Address - Phone:414-529-4600
Mailing Address - Fax:414-529-4689
Practice Address - Street 1:10731 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2555
Practice Address - Country:US
Practice Address - Phone:414-529-4600
Practice Address - Fax:414-529-4689
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1413-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38752500Medicaid
WIT61640Medicare UPIN