Provider Demographics
NPI:1780671925
Name:ROBERTS, EDWARD SCOTT (DC, MBA, BSME)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DC, MBA, BSME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1844
Mailing Address - Country:US
Mailing Address - Phone:530-222-2225
Mailing Address - Fax:530-226-9407
Practice Address - Street 1:260 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1844
Practice Address - Country:US
Practice Address - Phone:530-222-2225
Practice Address - Fax:530-226-9407
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06691Medicare UPIN