Provider Demographics
NPI:1457514556
Name:ROBERTS, RUSTY J (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSTY
Middle Name:J
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 1:3823 AIRPORT BLVD
Mailing Address - Street 2:STE A4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722
Mailing Address - Country:US
Mailing Address - Phone:512-522-7545
Mailing Address - Fax:
Practice Address - Street 1:3823 AIRPORT BLVD
Practice Address - Street 2:STE A4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722
Practice Address - Country:US
Practice Address - Phone:512-522-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor