Provider Demographics
NPI:1497846372
Name:KLEIN, ROBERT EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EVAN
Last Name:KLEIN
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-0105
Mailing Address - Country:US
Mailing Address - Phone:315-353-6655
Mailing Address - Fax:315-353-6656
Practice Address - Street 1:40 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NY
Practice Address - Zip Code:13668-1121
Practice Address - Country:US
Practice Address - Phone:315-353-6655
Practice Address - Fax:315-353-6656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001921-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO1921-8OtherNY WORKER'S COMP AUTHORIZ
NYT26402Medicare UPIN