Provider Demographics
NPI:1790003010
Name:ROBERTS, DANNY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:JOSEPH
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 1:215 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4556
Mailing Address - Country:US
Mailing Address - Phone:479-636-2804
Mailing Address - Fax:479-631-8201
Practice Address - Street 1:215 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4556
Practice Address - Country:US
Practice Address - Phone:479-636-2804
Practice Address - Fax:479-631-8201
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20705Medicare UPIN