Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-05089 | KS |
NPI | 1003944505 |
---|---|
Provider Name | Dr. Marc A Robertson |
First Address | Mcpherson, KS 67460-2839 |
Second Address | Mcpherson, KS 67460-2839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 22/03/2017 |