Provider Demographics
NPI:1043655384
Name:ROBERTS, NATHANIEL DREW (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DREW
Last Name:ROBERTS
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 1:2739 S 5600 W STE 170
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4633
Mailing Address - Country:US
Mailing Address - Phone:801-966-5106
Mailing Address - Fax:855-421-3750
Practice Address - Street 1:2739 S 5600 W
Practice Address - Street 2:STE 170
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-6091
Practice Address - Country:US
Practice Address - Phone:801-966-5106
Practice Address - Fax:801-966-5106
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8622553-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor