MEDICARE: DR. TODD C 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	2280	OK

General Provider Information

NPI Number	:	1154542173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD C ROBERTS D.C.

Provider Business Mailing Address
First Line	:	3931 E 60TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7832
Country	:	US
Telephone Number	:	918-850-9700
Fax Number	:	918-850-9700

Provider Business Practice Location Address
First Line	:	3931 E 60TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7832
Country	:	US
Telephone Number	:	918-850-9700
Fax Number	:	918-850-9700

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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