Provider Demographics
NPI:1609977982
Name:BREEN, ROBERT W (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:BREEN
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 1:8565 SUDLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3864
Mailing Address - Country:US
Mailing Address - Phone:703-368-4040
Mailing Address - Fax:
Practice Address - Street 1:8565 SUDLEY RD STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3864
Practice Address - Country:US
Practice Address - Phone:703-368-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT92994Medicare UPIN