Provider Demographics
NPI:1003944505
Name:ROBERTSON, MARC A (DC, ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DC, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2839
Mailing Address - Country:US
Mailing Address - Phone:620-241-2025
Mailing Address - Fax:620-241-6571
Practice Address - Street 1:817 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2839
Practice Address - Country:US
Practice Address - Phone:620-241-2025
Practice Address - Fax:620-241-6571
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor