Provider Demographics
NPI:1093709305
Name:CADWALLADER, ROBERT L (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:CADWALLADER
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 1:1777 W MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3100
Mailing Address - Country:US
Mailing Address - Phone:608-318-2410
Mailing Address - Fax:608-318-2412
Practice Address - Street 1:1777 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-3100
Practice Address - Country:US
Practice Address - Phone:608-318-2410
Practice Address - Fax:608-318-2412
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4350-012111N00000X
TN1362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN350050501OtherRAIL ROAD MEDICARE
TN3150790OtherBLUE CROSS BLUE SHEILD
TN3679068Medicaid
TN3150790OtherBLUE CROSS BLUE SHEILD
TNU68293Medicare UPIN