Provider Demographics
NPI:1770631152
Name:ROBERTSON, DANA L (DC, FASA)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DC, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2548
Mailing Address - Country:US
Mailing Address - Phone:573-642-1168
Mailing Address - Fax:573-592-8838
Practice Address - Street 1:305 MANOR DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2548
Practice Address - Country:US
Practice Address - Phone:573-642-1168
Practice Address - Fax:573-592-8838
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor