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NPI Code Detail

MEDICARE: DR. LEONARD J. ROBERTS DC

MEDICARE: DR. LEONARD J. ROBERTS DC
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
1111NS0005XSports Physician ChiropractorDC008037LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1906443OTHERPAHIGHMARK BS PROVIDER#
20856152000OTHERPAIBC/KEYSTONE- PROVIDER#
32671626OTHERPAAETNA PROVIDER#

General Provider Information

NPI Number : 1588627798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEONARD J. ROBERTS DC
Provider Business Mailing Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number : 215-487-7463
Provider Business Practice Location Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number : 215-487-7463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 06/25/2010

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1801117163 — ROBERTS FAMILY AND SPORTS CHIROPRACTIC
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1063712396 — NICOLE DEAN RD,LDN,CNSC
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Practice Fax:
1669775268 — ROBERTS FAMILY SPORTS AND CHIROPRACTIC
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PHILADELPHIA, PA
19128-2902
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1053747568 — MS. LAUREN CARVER RD, LDN
Practice Location Address:
8151 RIDGE AVE
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1982149787 — MR. MICHAEL ROBERT KEANE I L.AC., B.PH
Practice Location Address:
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Practice Fax:

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