Healthcare Provider Details

I. General information

NPI: 1417334210
Provider Name (Legal Business Name): JEREMY ANDREW ROBERTS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 E ANAHEIM ST STE 180
LONG BEACH CA
90804-4085
US

IV. Provider business mailing address

3720 E ANAHEIM ST STE 180
LONG BEACH CA
90804-4085
US

V. Phone/Fax

Practice location:
  • Phone: 562-986-2865
  • Fax:
Mailing address:
  • Phone: 562-986-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number33249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: