Provider Demographics
NPI:1942401310
Name:WAINER, ROBERT WOODROW (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WOODROW
Last Name:WAINER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13308 IVAKOTA FARM RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1542
Mailing Address - Country:US
Mailing Address - Phone:703-322-8344
Mailing Address - Fax:703-841-9196
Practice Address - Street 1:3924 WILSON BLVD.
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-528-2726
Practice Address - Fax:703-841-9196
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU67759Medicare UPIN