MEDICARE: KEVIN G. ROBERTS D.C., P.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	004431	MO

General Provider Information

NPI Number	:	1386823003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN G. ROBERTS D.C., P.C.

Provider Business Mailing Address
First Line	:	713 W MAIN ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1113
Country	:	US
Telephone Number	:	573-783-3188
Fax Number	:	573-783-3314

Provider Business Practice Location Address
First Line	:	713 W MAIN ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1113
Country	:	US
Telephone Number	:	573-783-3188
Fax Number	:	573-783-3314

Authorized Official
Title or Position	:	CHIROPRACTOR/ OWNER
Name	:	DR. KEVIN GERARD ROBERTS
Credential	:	D.C.
Telephone Number	:	573-783-3188

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	09/08/2023

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