Provider Demographics
NPI:1629102165
Name:ROBERTSON, SHARLA BROOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARLA
Middle Name:BROOKE
Last Name:ROBERTSON
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 1:5417 ACTON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-2994
Mailing Address - Country:US
Mailing Address - Phone:817-326-1174
Mailing Address - Fax:
Practice Address - Street 1:5417 ACTON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-2994
Practice Address - Country:US
Practice Address - Phone:817-326-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612396Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXV09174Medicare UPIN