Provider Demographics
NPI:1578677621
Name:TOLBERT, ROBERTA DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:DENISE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 TEW ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9547
Mailing Address - Country:US
Mailing Address - Phone:910-364-7413
Mailing Address - Fax:
Practice Address - Street 1:3202 N MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1831
Practice Address - Country:US
Practice Address - Phone:910-426-9112
Practice Address - Fax:910-426-3802
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor