Provider Demographics
NPI:1063701308
Name:ROBERTSON, REGINALD (DC)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:ROBERTSON
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 1:6441 N DURANGO DR
Mailing Address - Street 2:#130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4587
Mailing Address - Country:US
Mailing Address - Phone:702-538-9100
Mailing Address - Fax:702-478-6013
Practice Address - Street 1:6441 N DURANGO DR
Practice Address - Street 2:#130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4587
Practice Address - Country:US
Practice Address - Phone:702-538-9100
Practice Address - Fax:702-478-6013
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor