Provider Demographics
NPI:1437199692
Name:ROBERTSON, MATTHEW MILLER (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MILLER
Last Name:ROBERTSON
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 1:3121 SPRINGBANK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3346
Mailing Address - Country:US
Mailing Address - Phone:704-541-5353
Mailing Address - Fax:704-541-2131
Practice Address - Street 1:3121 SPRINGBANK LN
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3346
Practice Address - Country:US
Practice Address - Phone:704-541-5353
Practice Address - Fax:704-541-2131
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JJMedicaid
NC89085JJMedicaid