Provider Demographics
NPI:1407028715
Name:CHIROPRACTIC SPECIALIST OF WEATHERFORD & ASSOCIATES
Entity Type:Organization
Organization Name:CHIROPRACTIC SPECIALIST OF WEATHERFORD & ASSOCIATES
Other - Org Name:ROBERTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WARRAH
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-594-3434
Mailing Address - Street 1:1512 SANTA FE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5860
Mailing Address - Country:US
Mailing Address - Phone:817-594-3434
Mailing Address - Fax:817-594-7676
Practice Address - Street 1:1512 SANTA FE DR STE 103
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5860
Practice Address - Country:US
Practice Address - Phone:817-594-3434
Practice Address - Fax:817-594-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611432Medicare PIN