Provider Demographics
NPI:1659417251
Name:ROBERTS, BARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
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 1:4585 EMERALD VIS
Mailing Address - Street 2:G178
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-7203
Mailing Address - Country:US
Mailing Address - Phone:561-231-1647
Mailing Address - Fax:
Practice Address - Street 1:4585 EMERALD VIS
Practice Address - Street 2:G178
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-7203
Practice Address - Country:US
Practice Address - Phone:561-231-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVO7214Medicare UPIN
FL55512YMedicare ID - Type Unspecified