Provider Demographics
NPI:1437151891
Name:ROBERTSON, PLES JOHN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PLES
Middle Name:JOHN
Last Name:ROBERTSON
Suffix:JR
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 1:2114 S ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6000
Mailing Address - Country:US
Mailing Address - Phone:909-986-0878
Mailing Address - Fax:
Practice Address - Street 1:5496 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4201
Practice Address - Country:US
Practice Address - Phone:909-628-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953975467OtherOLD BLUE SHIELD ID NUMBER
CA953975467OtherOLD BLUE SHIELD ID NUMBER