Provider Demographics
NPI:1245493535
Name:ROBERTS & ROBERTS. A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:ROBERTS & ROBERTS. A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:562-633-1259
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-0786
Mailing Address - Country:US
Mailing Address - Phone:562-633-1259
Mailing Address - Fax:562-633-6549
Practice Address - Street 1:8019 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4325
Practice Address - Country:US
Practice Address - Phone:562-633-1259
Practice Address - Fax:562-633-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC2770Medicare PIN