Provider Demographics
NPI:1700985371
Name:ROBERTS, JONATHAN L
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0525
Mailing Address - Country:US
Mailing Address - Phone:316-283-2460
Mailing Address - Fax:
Practice Address - Street 1:230 W 6TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2131
Practice Address - Country:US
Practice Address - Phone:316-283-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059957OtherBCBS PROVIDER #
KST85088Medicare UPIN
KS059957OtherBCBS PROVIDER #