Provider Demographics
NPI:1306840798
Name:ROBERTSON, MICHAEL ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
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 1:6402 GARRISON CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7064
Mailing Address - Country:US
Mailing Address - Phone:360-608-1734
Mailing Address - Fax:
Practice Address - Street 1:6402 GARRISON CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-7064
Practice Address - Country:US
Practice Address - Phone:360-608-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COEL.2787472111NR0400X
TX11871111N00000X
COCHR.0008688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5690577OtherAETNA PROVIDER #
WA3964ROOtherRGENCE BLUE CROSS/BLUE SH
WA653147OtherACN
WA8850559Medicare UPIN