Provider Demographics
NPI:1992101901
Name:ROBERTS, MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:2704 MILAM ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3549
Mailing Address - Country:US
Mailing Address - Phone:713-360-6167
Mailing Address - Fax:
Practice Address - Street 1:2704 MILAM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3549
Practice Address - Country:US
Practice Address - Phone:713-360-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor