Healthcare Provider Details

I. General information

NPI: 1477641850
Provider Name (Legal Business Name): KEITH S ROBERTSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16169 HESPERIAN BLVD
SAN LORENZO CA
94580-2451
US

IV. Provider business mailing address

16169 HESPERIAN BLVD
SAN LORENZO CA
94580-2451
US

V. Phone/Fax

Practice location:
  • Phone: 510-276-7696
  • Fax: 510-276-7695
Mailing address:
  • Phone: 510-276-7696
  • Fax: 510-276-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: