Provider Demographics
NPI:1588627798
Name:ROBERTS, LEONARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:ROBERTS
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 1:8151 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2902
Mailing Address - Country:US
Mailing Address - Phone:215-487-2500
Mailing Address - Fax:215-487-7463
Practice Address - Street 1:8151 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2902
Practice Address - Country:US
Practice Address - Phone:215-487-2500
Practice Address - Fax:215-487-7463
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008037L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA906443OtherHIGHMARK BS PROVIDER#
PA0856152000OtherIBC/KEYSTONE- PROVIDER#
PA2671626OtherAETNA PROVIDER#
PA906443OtherHIGHMARK BS PROVIDER#