Provider Demographics
NPI:1912215302
Name:ROBERTS, ANDREW ENSIGN (MS, DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ENSIGN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18494 E CATTLE DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5177
Mailing Address - Country:US
Mailing Address - Phone:208-220-5868
Mailing Address - Fax:480-883-2289
Practice Address - Street 1:12220 E RIGGS RD
Practice Address - Street 2:SUIT 101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3738
Practice Address - Country:US
Practice Address - Phone:480-883-2266
Practice Address - Fax:480-883-2289
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1412111N00000X
AZ8346111N00000X
WY738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor