MEDICARE: DR. MICHAEL ANTHONY 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	111NR0400X	Rehabilitation Chiropractor	EL.2787472	CO
2	111N00000X	Chiropractor	11871	TX
3	111N00000X	Chiropractor	CHR.0008688	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5690577	OTHER	WA	AETNA PROVIDER #
2	3964RO	OTHER	WA	RGENCE BLUE CROSS/BLUE SH
3	653147	OTHER	WA	ACN

General Provider Information

NPI Number	:	1306840798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY ROBERTSON D.C.

Provider Business Mailing Address
First Line	:	6402 GARRISON CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7064
Country	:	US
Telephone Number	:	360-608-1734
Fax Number	:

Provider Business Practice Location Address
First Line	:	6402 GARRISON CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7064
Country	:	US
Telephone Number	:	360-608-1734
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/28/2023

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Directions to “ DR. MICHAEL ANTHONY ROBERTSON D.C.” Practice Location

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