Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038-007303 | IL |
NPI | 1083783450 |
---|---|
Provider Name | Dr. Frederic L Robertson |
First Address | Chicago, IL 60643-1831 |
Second Address | Chicago, IL 60643-1831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |