Provider Demographics
NPI:1750460127
Name:ISEN, BERT (DC)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:
Last Name:ISEN
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 1:16 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12009
Mailing Address - Country:US
Mailing Address - Phone:518-434-4408
Mailing Address - Fax:
Practice Address - Street 1:16 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12009
Practice Address - Country:US
Practice Address - Phone:518-434-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0042261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor