Provider Demographics
NPI:1750493169
Name:CEYNAR, ROBERT G (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:CEYNAR
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 1:54 25TH ST E
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6285
Mailing Address - Country:US
Mailing Address - Phone:701-572-8796
Mailing Address - Fax:
Practice Address - Street 1:54 25TH ST E
Practice Address - Street 2:SUITE C
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6285
Practice Address - Country:US
Practice Address - Phone:701-572-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4331OtherBLUE CROSS BLUE SHIELD
ND15344Medicaid
NDN4331Medicare ID - Type Unspecified
ND15344Medicaid