Provider Demographics
NPI:1982821286
Name:ROBERTS, CHARLES ALFRED (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALFRED
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 1:2835 US HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9706
Mailing Address - Country:US
Mailing Address - Phone:765-962-4308
Mailing Address - Fax:765-962-4308
Practice Address - Street 1:2835 US HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-9706
Practice Address - Country:US
Practice Address - Phone:765-962-4308
Practice Address - Fax:765-962-4308
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000079299OtherBLUE CROSS BLUE SHIELD
IN903220Medicare ID - Type Unspecified
INT 351 29Medicare UPIN