Provider Demographics
NPI:1144320656
Name:ROBERTS, CHARLES DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
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 1:2497 S ROANE ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8670
Mailing Address - Country:US
Mailing Address - Phone:865-882-5252
Mailing Address - Fax:865-882-5281
Practice Address - Street 1:2497 S ROANE ST
Practice Address - Street 2:SUITE 260
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8670
Practice Address - Country:US
Practice Address - Phone:865-882-5252
Practice Address - Fax:865-882-5281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC000251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0014531OtherBLUE CROSS& BLUE SHIELD
TNT74508Medicare UPIN
TN3677117Medicare ID - Type Unspecified