Provider Demographics
NPI:1902335177
Name:ROBERTSON, DANIELLE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N REDBUD CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-3215
Mailing Address - Country:US
Mailing Address - Phone:316-214-9403
Mailing Address - Fax:
Practice Address - Street 1:1220 S MERIDIAN AVE STE B
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-4969
Practice Address - Country:US
Practice Address - Phone:316-214-9403
Practice Address - Fax:316-214-9403
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor