Provider Demographics
NPI:1447356514
Name:BARTOSH, ROBERT A (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BARTOSH
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 1:1207 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-6028
Mailing Address - Country:US
Mailing Address - Phone:217-431-2010
Mailing Address - Fax:217-431-2011
Practice Address - Street 1:1207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-6028
Practice Address - Country:US
Practice Address - Phone:217-431-2010
Practice Address - Fax:217-431-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37773(G7860)Medicare UPIN