Provider Demographics
NPI:1598945610
Name:ROBERTSON, TREVOR OWEN (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:OWEN
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 1:5616 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7523
Mailing Address - Country:US
Mailing Address - Phone:858-454-3612
Mailing Address - Fax:858-454-3618
Practice Address - Street 1:5616 LA JOLLA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7523
Practice Address - Country:US
Practice Address - Phone:858-454-3612
Practice Address - Fax:858-454-3618
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor