Provider Demographics
NPI:1730300831
Name:ROBERTS WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:ROBERTS WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DIPL,AC
Authorized Official - Phone:913-385-5444
Mailing Address - Street 1:8901 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2208
Mailing Address - Country:US
Mailing Address - Phone:913-385-5444
Mailing Address - Fax:
Practice Address - Street 1:8901 W 75TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2208
Practice Address - Country:US
Practice Address - Phone:913-385-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4777111NN1001X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS59757OtherBCBS PROVIDER #
KS000B958Medicare ID - Type Unspecified
KS59757OtherBCBS PROVIDER #