Provider Demographics
NPI:1619907003
Name:DALTON, ROBERT S (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:DALTON
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 1:530 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3515
Mailing Address - Country:US
Mailing Address - Phone:585-266-2440
Mailing Address - Fax:
Practice Address - Street 1:530 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-266-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-05758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05758-0OtherWORKER COMP PROVIDER #
TX60054OtherAETNA
NY010005758OtherEXCELLUS PROVIDER #
NY33981BOtherMEDICARE PTAN
NY101867ANOtherPREFERRED CARE PROVIDER #
NY8664OtherBLUE SHIELD PROVIDER #