Healthcare Provider Details

I. General information

NPI: 1245493535
Provider Name (Legal Business Name): ROBERTS & ROBERTS. A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 JEFFERSON ST
PARAMOUNT CA
90723-4325
US

IV. Provider business mailing address

PO BOX 786
PARAMOUNT CA
90723-0786
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-1259
  • Fax: 562-633-6549
Mailing address:
  • Phone: 562-633-1259
  • Fax: 562-633-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11506
License Number StateCA

VIII. Authorized Official

Name: DR. RANDAL L ROBERTS
Title or Position: PRESIDENT
Credential: D.C., QME
Phone: 562-633-1259