Provider Demographics
NPI:1417334210
Name:ROBERTS, JEREMY ANDREW (DC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:ANDREW
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 1:3720 E ANAHEIM ST STE 180
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4085
Mailing Address - Country:US
Mailing Address - Phone:562-986-2865
Mailing Address - Fax:
Practice Address - Street 1:3720 E ANAHEIM ST STE 180
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4085
Practice Address - Country:US
Practice Address - Phone:562-986-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33249111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner