Provider Demographics
NPI:1912063363
Name:ROBINSON, DALE W (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:W
Last Name:ROBINSON
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0270
Mailing Address - Country:US
Mailing Address - Phone:503-829-6176
Mailing Address - Fax:503-829-6178
Practice Address - Street 1:317 N MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-8840
Practice Address - Country:US
Practice Address - Phone:503-829-6176
Practice Address - Fax:503-829-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
930742605OtherFED TAX ID
R0000QGHGQMedicare ID - Type UnspecifiedMEDICARE PROVIDER #