Provider Demographics
NPI:1215984984
Name:BADER, C ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:C ROBERT
Middle Name:
Last Name:BADER
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 1:5050 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4521
Mailing Address - Country:US
Mailing Address - Phone:716-634-2802
Mailing Address - Fax:716-634-2357
Practice Address - Street 1:5050 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4521
Practice Address - Country:US
Practice Address - Phone:716-634-2802
Practice Address - Fax:716-634-2357
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0042061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000200653001OtherBC BS
NY02663505Medicaid
0005862331OtherAETNA
NYC042061OtherWORKERS COMPENSATION
0002033860LOtherUNIVERA
NYC042061OtherWORKERS COMPENSATION
0002033860LOtherUNIVERA