Provider Demographics
NPI:1134342959
Name:PRIEBE, ROBERT H (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:PRIEBE
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 1:1216 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4300
Mailing Address - Country:US
Mailing Address - Phone:847-489-2300
Mailing Address - Fax:
Practice Address - Street 1:1216 HARDING AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4300
Practice Address - Country:US
Practice Address - Phone:847-489-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200642374OtherTAX ID
ILV00587Medicare ID - Type Unspecified
ILK08140Medicare UPIN