Provider Demographics
NPI:1275688921
Name:ROBERTSON, DENNIS MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:ROBERTSON
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 1:777 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2302
Mailing Address - Country:US
Mailing Address - Phone:559-222-6262
Mailing Address - Fax:559-222-2262
Practice Address - Street 1:777 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2302
Practice Address - Country:US
Practice Address - Phone:559-222-6262
Practice Address - Fax:559-222-2262
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor