Provider Demographics
NPI:1508361312
Name:ROBERTSON, CONNOR DAVIS
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:DAVIS
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 DOG LEG DR
Mailing Address - Street 2:
Mailing Address - City:PRESTO
Mailing Address - State:PA
Mailing Address - Zip Code:15142-1585
Mailing Address - Country:US
Mailing Address - Phone:315-237-3784
Mailing Address - Fax:
Practice Address - Street 1:701 BOYCE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1225
Practice Address - Country:US
Practice Address - Phone:724-942-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor