Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL | |
N | 111N00000X | Chiropractor | 5465 | FL |
NPI | 1003804154 |
---|---|
Provider Name | Dr. Robert M. Bernacki |
First Address | Schaumburg, IL 60173-4701 |
Second Address | Schaumburg, IL 60173-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1627529 | BLUE CROSS (01) | IL |
U84654 | (02) |