Provider Demographics
NPI:1629114731
Name:JAEGER, ROBERTA D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:D
Last Name:JAEGER
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 1:30 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2575
Mailing Address - Country:US
Mailing Address - Phone:978-452-4223
Mailing Address - Fax:978-452-1511
Practice Address - Street 1:30 GORHAM ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2575
Practice Address - Country:US
Practice Address - Phone:978-452-4223
Practice Address - Fax:978-452-1511
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348111N00000X
NY009261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468521OtherTUFTS HEALTH PLAN
MA1601067Medicaid
MAY36673OtherBCBS OF MASSACHUSETTS
MA352291OtherHARVARD PLIGRIM HEALTH PL
MA0027885OtherNEIGHBORHOOD HEALTH PLAN
MA2554325OtherAETNA HEALTH PLAN
MA97718801OtherNETWORK HEALTH
MA352291OtherHARVARD PLIGRIM HEALTH PL