Provider Demographics
NPI:1588294920
Name:ROBERTS, MADISON KAY
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BRIGHTSAND CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3901
Mailing Address - Country:US
Mailing Address - Phone:515-771-8873
Mailing Address - Fax:
Practice Address - Street 1:1809 HERITAGE HILLS DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4624
Practice Address - Country:US
Practice Address - Phone:515-771-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor