Provider Demographics
NPI:1720498058
Name:ROBERTS, EDWARD ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANDREW
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 1:1710 GALLATIN PIKE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2122
Mailing Address - Country:US
Mailing Address - Phone:615-645-9994
Mailing Address - Fax:615-915-0389
Practice Address - Street 1:1710 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-645-0994
Practice Address - Fax:615-915-3989
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor