Provider Demographics
NPI:1922469733
Name:ROBERTS, MARK CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
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 1:6809 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1434
Mailing Address - Country:US
Mailing Address - Phone:772-466-4006
Mailing Address - Fax:772-466-4007
Practice Address - Street 1:6809 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1434
Practice Address - Country:US
Practice Address - Phone:772-466-4006
Practice Address - Fax:772-466-4007
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2277111N00000X
FL12370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor