MEDICARE: DR. DARCI ROBERTSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	32206	CA

General Provider Information

NPI Number	:	1225301518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARCI ROBERTSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 835
Second Line	:
City	:	LOS ALAMOS
State	:	CA
Zip	:	93440-0835
Country	:	US
Telephone Number	:	831-588-7425
Fax Number	:	805-344-3493

Provider Business Practice Location Address
First Line	:	2027 VILLAGE LN
Second Line	:	SUITE 202
City	:	SOLVANG
State	:	CA
Zip	:	93463-2283
Country	:	US
Telephone Number	:	805-688-9426
Fax Number	:	805-688-2076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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