MEDICARE: DR. PHILIP E ROBERTS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1075	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134184799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP E ROBERTS D.C.

Provider Business Mailing Address
First Line	:	302 N GREENWOOD AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3454
Country	:	US
Telephone Number	:	479-782-9505
Fax Number	:	479-782-7505

Provider Business Practice Location Address
First Line	:	302 N GREENWOOD AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3454
Country	:	US
Telephone Number	:	479-782-9505
Fax Number	:	479-782-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	11/26/2014

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