Provider Demographics
NPI:1609128040
Name:MR & MRS ROBERT ADLER
Entity Type:Organization
Organization Name:MR & MRS ROBERT ADLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-646-1555
Mailing Address - Street 1:17 E PERU ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2031
Mailing Address - Country:US
Mailing Address - Phone:815-872-1800
Mailing Address - Fax:815-872-1800
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:815-872-1800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MR & MRS ROBERT ADLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.009905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty