Provider Demographics
NPI:1437116993
Name:MCROBERTS, TIMOTHY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:MCROBERTS
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 1:1960 RANGE TRL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9359
Mailing Address - Country:US
Mailing Address - Phone:608-848-0723
Mailing Address - Fax:608-848-0059
Practice Address - Street 1:951 KIMBALL LANE
Practice Address - Street 2:SUITE 122
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9122
Practice Address - Country:US
Practice Address - Phone:608-848-0058
Practice Address - Fax:608-848-0059
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI03755-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38934100Medicaid
WIU87651Medicare UPIN
WI38934100Medicaid