Provider Demographics
NPI:1881890689
Name:ROBERTSON-MOORE, DEBRA K (DC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:ROBERTSON-MOORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-4412
Mailing Address - Country:US
Mailing Address - Phone:913-234-0638
Mailing Address - Fax:
Practice Address - Street 1:10850 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1613
Practice Address - Country:US
Practice Address - Phone:913-234-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor