MEDICARE: DR. JEFFREY ALAN ROBERTS 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	111N00000X	Chiropractor	4427	KY

General Provider Information

NPI Number	:	1386647071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN ROBERTS D.C.

Provider Business Mailing Address
First Line	:	496 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-6555
Fax Number	:	270-692-5751

Provider Business Practice Location Address
First Line	:	496 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-6555
Fax Number	:	270-692-5751

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/20/2008

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