Provider Demographics
NPI:1336103829
Name:ROBERTS, SANDRA (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5457
Mailing Address - Country:US
Mailing Address - Phone:407-847-6788
Mailing Address - Fax:407-847-7507
Practice Address - Street 1:22 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5457
Practice Address - Country:US
Practice Address - Phone:407-847-6788
Practice Address - Fax:407-847-7507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54826Medicare UPIN