Provider Demographics
NPI:1962575399
Name:ROBERTS, JEFFREY T
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1264
Mailing Address - Country:US
Mailing Address - Phone:603-924-4994
Mailing Address - Fax:603-924-0837
Practice Address - Street 1:471 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1264
Practice Address - Country:US
Practice Address - Phone:603-924-4994
Practice Address - Fax:603-924-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH09909530882A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30250135Medicaid
NH30250135Medicaid
NHNH8428Medicare ID - Type Unspecified