Provider Demographics
NPI:1003816067
Name:PYNE, ROBERT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:PYNE
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 1:10413 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1931
Mailing Address - Country:US
Mailing Address - Phone:708-599-9585
Mailing Address - Fax:708-599-9598
Practice Address - Street 1:10413 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1931
Practice Address - Country:US
Practice Address - Phone:708-599-9585
Practice Address - Fax:708-599-9598
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005416111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001682418OtherBLUECROSS/BLUESHIELD
ILK51576Medicare PIN
IL0001682418OtherBLUECROSS/BLUESHIELD
ILK51573Medicare PIN