Provider Demographics
NPI:1053497511
Name:IWANIEC, ROBERT JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:IWANIEC
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 1:133 COLUMBIA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144
Mailing Address - Country:US
Mailing Address - Phone:518-432-7951
Mailing Address - Fax:518-432-7421
Practice Address - Street 1:133 COLUMBIA TURNPIKE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-432-7951
Practice Address - Fax:518-432-7421
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005647111N00000X
VA0104001440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10015844OtherCDPHP
NYX44341OtherEBCBS
NYCO5647OtherWCB
U13409Medicare UPIN
NY10015844OtherCDPHP