Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC-006306-L | PA |
NPI | 1023189248 |
---|---|
Provider Name | Dr. Robert George Bittenbender JR. |
First Address | Freeland, PA 18224-3306 |
Second Address | Freeland, PA 18224-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
777655 | PA BLUE CROSS OF N.E. PA (01) | PA |