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General NPI Number Information
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NPI Number | 1649580044
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Entity Type | Organization
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Legal Business Name | ROBERDS CHIROPRACTIC CLINIC PLLC
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 4038 N REMINGTON DR SUITE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6345
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Country | US
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Telephone | 479-582-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 4038 N REMINGTON DR SUITE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARLA ROBERDS
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Credential |
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Telephone | 479-582-1444
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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 | 977
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License Number State | AR
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