Provider Demographics
NPI:1083744056
Name:RECTENWALD, ROBERT JOHN JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:RECTENWALD
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 1:1415 BARCLAY CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2943
Mailing Address - Country:US
Mailing Address - Phone:404-606-8727
Mailing Address - Fax:404-606-8727
Practice Address - Street 1:1415 BARCLAY CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2943
Practice Address - Country:US
Practice Address - Phone:404-606-8727
Practice Address - Fax:404-606-8727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor