Provider Demographics
NPI:1891888988
Name:ROBERTS, MATTHEW D (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
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 1:450B WASHINGTON JACKSON RD STE 109
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7601
Mailing Address - Country:US
Mailing Address - Phone:937-456-8368
Mailing Address - Fax:937-456-8369
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 109
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8368
Practice Address - Fax:937-456-8369
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV05189Medicare UPIN
OHMA4158991Medicare ID - Type Unspecified