1457416182 NPI number — ROBERTS CHIROPRACTIC,PLLC

Table of content: (NPI 1457416182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457416182 NPI number — ROBERTS CHIROPRACTIC,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERTS CHIROPRACTIC,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROGER W. ROBERTS, D.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457416182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1819 PASEO SAN LUIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-452-1490
Provider Business Mailing Address Fax Number:
520-452-9797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1819 PASEO SAN LUIS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-452-1490
Provider Business Practice Location Address Fax Number:
520-452-9797
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARIMER
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
520-452-1490

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5348 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5258158 . This is a "CCN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 612607200 . This is a "OWCP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: DF9565 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0240640 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1937602856 . This is a "FIRST HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 23025348 . This is a "WC STATE FUND" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com