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General NPI Number Information
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NPI Number | 1922044825
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Entity Type | Organization
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Legal Business Name | ROBERTS FAMILY & SPORTS CHIROPRACTIC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 8151 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2902
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Country | US
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Telephone | 215-487-2500
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Fax | 215-487-7463
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Provider Business Mailing Address
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Address Line | 8151 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2902
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Country | US
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Telephone | 215-487-2500
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Fax | 215-487-7463
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEONARD J ROBERTS
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Credential | DC
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Telephone | 215-487-2500
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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 | DC008037L
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License Number State | PA
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