Provider Demographics
NPI:1730358565
Name:TIMOTHY D ROBERTS
Entity type:Organization
Organization Name:TIMOTHY D ROBERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-587-4605
Mailing Address - Street 1:8800 S TAMIAMI TRL
Mailing Address - Street 2:STE A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3142
Mailing Address - Country:US
Mailing Address - Phone:941-918-9195
Mailing Address - Fax:941-918-9474
Practice Address - Street 1:8800 S TAMIAMI TRL
Practice Address - Street 2:STE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-3142
Practice Address - Country:US
Practice Address - Phone:941-918-9195
Practice Address - Fax:941-918-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty