Provider Demographics
NPI:1962572883
Name:STRANGE, ROBERT A (DC LAC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:STRANGE
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MERRITT AVE.
Mailing Address - Street 2:PO BOX 725
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-0725
Mailing Address - Country:US
Mailing Address - Phone:845-677-5410
Mailing Address - Fax:845-677-4163
Practice Address - Street 1:3 MERRITT AVE.
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-0725
Practice Address - Country:US
Practice Address - Phone:845-677-5410
Practice Address - Fax:845-677-4163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004397-1111N00000X
NY003463-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7233K2OtherBLUECROSS/ BLUE SHIELD
NY4397-8BOtherWORK COMP BOARD
NY820148OtherMANAGED PHYSICAL NETWORK
NYX32R71OtherBLUE CROSS/ BLUE SHIELD
NYX25421Medicare PIN