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NPI Code Detail

MEDICARE: ROBERTS FAMILY AND SPORTS CHIROPRACTIC

MEDICARE: ROBERTS FAMILY AND SPORTS CHIROPRACTIC
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
1133V00000XRegistered DietitianDN004015PA

General Provider Information

NPI Number : 1801117163
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERTS FAMILY AND SPORTS CHIROPRACTIC
Provider Business Mailing Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number : 215-487-7463
Provider Business Practice Location Address
First Line : 8151 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2902
Country : US
Telephone Number : 215-487-2500
Fax Number : 215-487-7463
Authorized Official
Title or Position : OWNER/CHIROPRACTOR
Name : DR. LENNY ROBERTS
Credential :
Telephone Number : 215-487-2500
Provider Enumeration Date : 06/21/2010
Last Update Date : 06/30/2010

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1982149787 — MR. MICHAEL ROBERT KEANE I L.AC., B.PH
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Directions to “ROBERTS FAMILY AND SPORTS CHIROPRACTIC ” Practice Location

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