Provider Demographics
NPI:1164459616
Name:ROBERTS, CARLY M (DC)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:M
Last Name:ROBERTS
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 1:4307 FACTORIA BULAVARD SOUTH EAST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-747-5657
Mailing Address - Fax:425-747-5334
Practice Address - Street 1:4307 FACTORIA BLVD SOUTH EAST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-747-5657
Practice Address - Fax:425-747-5334
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor