Provider Demographics
NPI:1447247234
Name:ROBERTS, ROGER W (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 PASEO SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4613
Mailing Address - Country:US
Mailing Address - Phone:520-452-1490
Mailing Address - Fax:520-452-9797
Practice Address - Street 1:1819 PASEO SAN LUIS
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4613
Practice Address - Country:US
Practice Address - Phone:520-452-1490
Practice Address - Fax:520-452-9797
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ612607200OtherOWCP
AZAZ0240640OtherBLUE CROSS BLUE SHIELD
AZ23025348OtherWC STATE FUND
AZ5258158OtherCCN
AZPOO405129OtherRAILROAD MEDICARE
AZ1937602856OtherFIRST HEALTH
AZU53719Medicare UPIN
AZ612607200OtherOWCP