Provider Demographics
NPI:1144999749
Name:SEQUEIRA-ROBERTS LLC
Entity type:Organization
Organization Name:SEQUEIRA-ROBERTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-307-5848
Mailing Address - Street 1:15412 ADLONG DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3309
Mailing Address - Country:US
Mailing Address - Phone:817-307-5848
Mailing Address - Fax:
Practice Address - Street 1:6100 COLLEYVILLE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8025
Practice Address - Country:US
Practice Address - Phone:817-307-5848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty