Provider Demographics
NPI:1154542173
Name:ROBERTS, TODD C (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:C
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 1:3931 E 60TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7832
Mailing Address - Country:US
Mailing Address - Phone:918-850-9700
Mailing Address - Fax:918-850-9700
Practice Address - Street 1:3931 E 60TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7832
Practice Address - Country:US
Practice Address - Phone:918-850-9700
Practice Address - Fax:918-850-9700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor