Healthcare Provider Details

I. General information

NPI: 1134184799
Provider Name (Legal Business Name): PHILIP E ROBERTS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

IV. Provider business mailing address

302 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

V. Phone/Fax

Practice location:
  • Phone: 479-782-9505
  • Fax: 479-782-7505
Mailing address:
  • Phone: 479-782-9505
  • Fax: 479-782-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: