Provider Demographics
NPI:1336647668
Name:MARK CHRISTOPHER ROBERTS DC LLC
Entity Type:Organization
Organization Name:MARK CHRISTOPHER ROBERTS DC LLC
Other - Org Name:SYKES CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-466-4006
Mailing Address - Street 1:6809 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1434
Mailing Address - Country:US
Mailing Address - Phone:772-466-4006
Mailing Address - Fax:722-466-4007
Practice Address - Street 1:6809 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1434
Practice Address - Country:US
Practice Address - Phone:772-466-4006
Practice Address - Fax:772-466-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty