Basic Information
| Provider Information | |||||||||
| NPI: | 1003804154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNACKI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 714 E HIGGINS RD | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475191090 | ||||||||
| FaxNumber: | 8475190599 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 E HIGGINS RD | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475191090 | ||||||||
| FaxNumber: | 8475190599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5465 | FL | N | Chiropractic Providers | Chiropractor | 111N00000X | IL | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 1627529 | 01 | IL | BLUE CROSS | OTHER |