Provider Demographics
NPI:1083783450
Name:ROBERTSON, FREDERIC L (DN, DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9948 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1831
Mailing Address - Country:US
Mailing Address - Phone:773-445-6800
Mailing Address - Fax:773-445-2499
Practice Address - Street 1:9948 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1831
Practice Address - Country:US
Practice Address - Phone:773-445-6800
Practice Address - Fax:773-445-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007303111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation