Provider Demographics
NPI:1356649537
Name:NIEHAUS, ROBIN RENEE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3234
Mailing Address - Country:US
Mailing Address - Phone:217-877-8992
Mailing Address - Fax:217-877-8978
Practice Address - Street 1:2870 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3234
Practice Address - Country:US
Practice Address - Phone:217-877-8992
Practice Address - Fax:217-877-8978
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5360Medicare PIN