Provider Demographics
NPI:1972780153
Name:DR. ROBERT WRIEDEN DC PLLC
Entity Type:Organization
Organization Name:DR. ROBERT WRIEDEN DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:WRIEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-336-7030
Mailing Address - Street 1:60 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1542
Mailing Address - Country:US
Mailing Address - Phone:607-336-7030
Mailing Address - Fax:800-341-6751
Practice Address - Street 1:60 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1542
Practice Address - Country:US
Practice Address - Phone:607-336-7030
Practice Address - Fax:800-341-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD2370Medicare PIN
NYU27287Medicare UPIN