Provider Demographics
NPI:1568449957
Name:KLANCHAR, ROBERT JOHN JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:KLANCHAR
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 801
Mailing Address - Street 2:1735 ROSTRAVER RD
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-0801
Mailing Address - Country:US
Mailing Address - Phone:724-929-8353
Mailing Address - Fax:724-929-2860
Practice Address - Street 1:1735 ROSTRAVER RD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-0801
Practice Address - Country:US
Practice Address - Phone:724-929-8353
Practice Address - Fax:724-929-2860
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004947L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7056984Medicaid
U29374Medicare UPIN
PA709478Medicare ID - Type Unspecified