Provider Demographics
NPI:1912958372
Name:OTTEN, ROBERT JR (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:OTTEN
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:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12496-0718
Mailing Address - Country:US
Mailing Address - Phone:518-734-6176
Mailing Address - Fax:518-734-6237
Practice Address - Street 1:5414 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NY
Practice Address - Zip Code:12496-5802
Practice Address - Country:US
Practice Address - Phone:518-734-6176
Practice Address - Fax:518-734-6237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005393-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor