Provider Demographics
NPI:1639235161
Name:PRIVRATSKY, ROBERT NEIL JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:PRIVRATSKY
Suffix:JR
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 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2761
Mailing Address - Country:US
Mailing Address - Phone:612-345-5376
Mailing Address - Fax:
Practice Address - Street 1:1216 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2761
Practice Address - Country:US
Practice Address - Phone:612-345-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00528111N00000X
CADC-30794111N00000X
MN6568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI359004447Medicare UPIN
RI007058073Medicare ID - Type UnspecifiedLINK TO GROUP
RI359004471Medicare ID - Type UnspecifiedGROUP