Provider Demographics
NPI:1336791847
Name:ROBERTSON, GERALD D (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:ROBERTSON
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 1:1566 S ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340
Mailing Address - Country:US
Mailing Address - Phone:660-886-5850
Mailing Address - Fax:660-886-7333
Practice Address - Street 1:1566 S ODELL AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340
Practice Address - Country:US
Practice Address - Phone:660-886-5850
Practice Address - Fax:660-886-7333
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008010111NP0017X
MO2020025322111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor