Provider Demographics
NPI:1538268925
Name:ROBERTS, PATRICK J JR (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:ROBERTS
Suffix:JR
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 1:280 E MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7324
Mailing Address - Country:US
Mailing Address - Phone:302-737-8667
Mailing Address - Fax:
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:111
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7333
Practice Address - Country:US
Practice Address - Phone:302-737-8667
Practice Address - Fax:302-737-8667
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007753-1111N00000X
PADC005512L111N00000X
DEF1-000368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE348735OtherAMERIHEALTH
257136OtherMAMSI
DE0680077OtherAETNA
PANE 348735OtherPA BLUE SHIELD
PANE 348735OtherPA BLUE SHIELD
DERO 143867Medicare ID - Type Unspecified