MEDICARE: ROBERTS FAMILY CHIROPRACTIC, LLC

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	CH7267	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH 7267	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1659771251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTS FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	4585 EMERALD VIS
Second Line	:	G178
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-7203
Country	:	US
Telephone Number	:	561-231-1647
Fax Number	:

Provider Business Practice Location Address
First Line	:	4585 EMERALD VIS
Second Line	:	G178
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-7203
Country	:	US
Telephone Number	:	561-231-1647
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CHIROPRACTOR
Name	:	DR. BARRY ROBERTS
Credential	:	DC
Telephone Number	:	561-231-1647

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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