Provider Demographics
NPI:1891898359
Name:ROBERTSON, JAMES ROBBIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBBIE
Last Name:ROBERTSON
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 1:2918 SAINT MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3715
Mailing Address - Country:US
Mailing Address - Phone:573-221-5555
Mailing Address - Fax:573-221-5765
Practice Address - Street 1:2918 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3715
Practice Address - Country:US
Practice Address - Phone:573-221-5555
Practice Address - Fax:573-221-5765
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010206111N00000X
MO2004022080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07551142OtherBCBS OF IL
MOP00452283OtherRR MEDICARE
MO000000 515852OtherANTHEM BCBS
IL702659OtherHEALTHLINK
MO702659OtherHEALTHLINK
MO702659OtherHEALTHLINK
IL07551142OtherBCBS OF IL
MOPTAN 000015136Medicare PIN
MO000015136Medicare UPIN