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General NPI Number Information
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NPI Number | 1871789347
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Entity Type | Organization
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Legal Business Name | DR GORDON L ROBERTS PLLC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 3426 M-40
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City | HAMILTON
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State | MI
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Zip | 49419
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Country | US
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Telephone | 269-751-2670
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Fax | 269-751-2680
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Provider Business Mailing Address
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Address Line | 3426 M-40
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City | HAMILTON
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State | MI
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Zip | 49419
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Country | US
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Telephone | 269-751-2670
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Fax | 269-751-2680
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Authorized Official
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Title or Position | OWNER
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Name | GORDON LEE ROBERTS
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Credential | DC
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Telephone | 269-751-2670
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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 | GR004365
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License Number State | MI
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