=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023228491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERTSON CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 LEE ST E
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25301-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-342-1442
-----------------------------------------------------
Fax | 304-342-1442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 LEE ST E
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25301-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-342-1442
-----------------------------------------------------
Fax | 304-342-1442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. CHARLES D ROBERTSON II
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 304-342-1442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 699
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------