Provider Demographics
NPI:1982623351
Name:ROBERTSON, KARI RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:RENEE
Last Name:ROBERTSON
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 1:65 E WACKER PL
Mailing Address - Street 2:1615
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7296
Mailing Address - Country:US
Mailing Address - Phone:312-853-3732
Mailing Address - Fax:
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:1615
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:312-853-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636613OtherBLUE CROSS BLUE SHIELD
IL01636613OtherBLUE CROSS BLUE SHIELD