Provider Demographics
NPI:1659771251
Name:ROBERTS FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ROBERTS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-231-1647
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH 7267OtherLICENSE
FLV07214Medicare UPIN