Provider Demographics
NPI:1043376080
Name:ADLER, ROBERT MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:ADLER
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 1:16537 1200 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WYANET
Mailing Address - State:IL
Mailing Address - Zip Code:61379-9516
Mailing Address - Country:US
Mailing Address - Phone:818-646-1555
Mailing Address - Fax:
Practice Address - Street 1:17 E PERU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2031
Practice Address - Country:US
Practice Address - Phone:815-872-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor