MEDICARE: ROBERTS CHIROPRACTIC,PLLC

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	5348	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DF9565	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5258158	OTHER	AZ	CCN
2	612607200	OTHER	AZ	OWCP
4	AZ0240640	OTHER	AZ	BLUE CROSS BLUE SHIELD
5	1937602856	OTHER	AZ	FIRST HEALTH
6	23025348	OTHER	AZ	WC STATE FUND

General Provider Information

NPI Number	:	1457416182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTS CHIROPRACTIC,PLLC

Provider Business Mailing Address
First Line	:	1819 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-452-1490
Fax Number	:	520-452-9797

Provider Business Practice Location Address
First Line	:	1819 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-452-1490
Fax Number	:	520-452-9797

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ERICA LARIMER
Credential	:
Telephone Number	:	520-452-1490

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	05/02/2017

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