MEDICARE: DR. MATTHEW D 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	3647	OH

General Provider Information

NPI Number	:	1891888988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW D ROBERTS D.C.

Provider Business Mailing Address
First Line	:	450B WASHINGTON JACKSON RD STE 109
Second Line	:
City	:	EATON
State	:	OH
Zip	:	45320-7601
Country	:	US
Telephone Number	:	937-456-8368
Fax Number	:	937-456-8369

Provider Business Practice Location Address
First Line	:	450B WASHINGTON JACKSON RD STE 109
Second Line	:
City	:	EATON
State	:	OH
Zip	:	45320-7601
Country	:	US
Telephone Number	:	937-456-8368
Fax Number	:	937-456-8369

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/14/2014

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