Provider Demographics
NPI:1326167370
Name:ROBERTS, JOHN WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
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 1:5201 BABCOCK ST NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4637
Mailing Address - Country:US
Mailing Address - Phone:321-725-5200
Mailing Address - Fax:321-725-8770
Practice Address - Street 1:5201 BABCOCK ST NE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4637
Practice Address - Country:US
Practice Address - Phone:321-725-5200
Practice Address - Fax:321-725-8770
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5772111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22202OtherBLUE CROSS BLUE SHEILD NU