Provider Demographics
NPI:1396850590
Name:ROBINSON, RAINA L (DC)
Entity type:Individual
Prefix:MRS
First Name:RAINA
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:RAINA
Other - Middle Name:L
Other - Last Name:NELLENBACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:11444 STATE ROUTE 12
Mailing Address - City:ALDER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13301
Mailing Address - Country:US
Mailing Address - Phone:315-831-3913
Mailing Address - Fax:
Practice Address - Street 1:11444 ST. RT. 12
Practice Address - Street 2:
Practice Address - City:ALDER CREEK
Practice Address - State:NY
Practice Address - Zip Code:13301-0126
Practice Address - Country:US
Practice Address - Phone:315-831-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0093541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U78663Medicare UPIN
BB8678Medicare ID - Type Unspecified