Provider Demographics
NPI:1093758377
Name:ROBERTS, BRIANNA JOY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:JOY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 RAVOUX CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2407
Mailing Address - Country:US
Mailing Address - Phone:612-501-8658
Mailing Address - Fax:
Practice Address - Street 1:328 HERITAGE PL
Practice Address - Street 2:SUITE A
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:507-332-2206
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN863527700OtherMINNESOTA CARE
MN863527700OtherMINNESOTA CARE