Provider Demographics
NPI:1669522355
Name:PHILIP E.ROBERTS, P.A.
Entity type:Organization
Organization Name:PHILIP E.ROBERTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-782-9505
Mailing Address - Street 1:302 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3454
Mailing Address - Country:US
Mailing Address - Phone:479-782-9505
Mailing Address - Fax:479-782-7505
Practice Address - Street 1:302 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3454
Practice Address - Country:US
Practice Address - Phone:479-782-9505
Practice Address - Fax:479-782-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148222718Medicaid
AR5F380Medicare PIN