=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669727350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. EDWIN ROBERTS CHIROPRACTIC, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2012
-----------------------------------------------------
Last Update Date | 07/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4469 MOBILE HWY
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32506-8241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-572-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4469 MOBILE HWY
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32506-8241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-572-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. EDWIN PAUL ROBERTS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 850-572-5329
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------