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General NPI Number Information
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NPI Number | 1598079873
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Entity Type | Individual
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Provider Name | NATHAN BRYAN ROBERTS DC
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Gender | Male
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 125 W MONROE ST
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City | BANGOR
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State | MI
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Zip | 49013-1332
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Country | US
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Telephone | 269-427-2800
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Fax | 269-621-2556
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | BANGOR
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State | MI
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Zip | 49013-0124
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Country | US
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Telephone | 734-845-9064
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Fax | 734-557-4000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | NR009713
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License Number State | MI
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