Provider Demographics
NPI:1386823003
Name:KEVIN G. ROBERTS D.C., P.C.
Entity Type:Organization
Organization Name:KEVIN G. ROBERTS D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-783-3188
Mailing Address - Street 1:713 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1113
Mailing Address - Country:US
Mailing Address - Phone:573-783-3188
Mailing Address - Fax:573-783-3314
Practice Address - Street 1:713 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1113
Practice Address - Country:US
Practice Address - Phone:573-783-3188
Practice Address - Fax:573-783-3314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEVIN G. ROBERTS D.C., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000013947Medicare PIN