Provider Demographics
NPI:1922044825
Name:ROBERTS FAMILY & SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:ROBERTS FAMILY & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-487-2500
Mailing Address - Street 1:8151 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2902
Mailing Address - Country:US
Mailing Address - Phone:215-487-2500
Mailing Address - Fax:215-487-7463
Practice Address - Street 1:8151 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2902
Practice Address - Country:US
Practice Address - Phone:215-487-2500
Practice Address - Fax:215-487-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008037L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0856152000OtherIBC
PA2671626OtherAENTA NON HMO
DE163629449OtherAMERIHEALTH ADMINISTRATOR
NJ163629449OtherAMERIHEALTH ADMINISTRATOR
PA0856152000OtherKEYSTONE HEALTH PLAN EAST
PA906443OtherHIGHMARK BLUE SHIELD
PA0856152000OtherKEYSTONE HEALTH PLAN EAST