Provider Demographics
NPI:1588668552
Name:ROBERTS, THOMAS A (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
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 1:730 N NEW WARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4247
Mailing Address - Country:US
Mailing Address - Phone:850-456-4788
Mailing Address - Fax:
Practice Address - Street 1:730 N NEW WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4247
Practice Address - Country:US
Practice Address - Phone:850-456-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050444100Medicaid
FL5673008OtherAETNA INSURANCE
FL70632ZOtherMEDICARE PTAN
FL350019603OtherRAILROAD MEDICARE
FL70632OtherBLUE SHIELD OF FLORIDA
FL70632Medicare ID - Type Unspecified
FL5673008OtherAETNA INSURANCE