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General NPI Number Information
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NPI Number | 1386823003
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Entity Type | Organization
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Legal Business Name | KEVIN G. ROBERTS D.C., P.C.
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 713 W MAIN ST
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-1113
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Country | US
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Telephone | 573-783-3188
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Fax | 573-783-3314
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Provider Business Mailing Address
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Address Line | 713 W MAIN ST
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-1113
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Country | US
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Telephone | 573-783-3188
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Fax | 573-783-3314
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | DR. KEVIN GERARD ROBERTS
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Credential | D.C.
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Telephone | 573-783-3188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 004431
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License Number State | MO
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