Provider Demographics
NPI:1457416182
Name:ROBERTS CHIROPRACTIC,PLLC
Entity Type:Organization
Organization Name:ROBERTS CHIROPRACTIC,PLLC
Other - Org Name:ROGER W. ROBERTS, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-452-1490
Mailing Address - Street 1:1819 PASEO SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4613
Mailing Address - Country:US
Mailing Address - Phone:520-452-1490
Mailing Address - Fax:520-452-9797
Practice Address - Street 1:1819 PASEO SAN LUIS
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4613
Practice Address - Country:US
Practice Address - Phone:520-452-1490
Practice Address - Fax:520-452-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5258158OtherCCN
AZ612607200OtherOWCP
AZDF9565OtherRAILROAD MEDICARE
AZAZ0240640OtherBLUE CROSS BLUE SHIELD
AZ1937602856OtherFIRST HEALTH
AZ23025348OtherWC STATE FUND
AZU53719Medicare UPIN
AZDF9565OtherRAILROAD MEDICARE