Active NPI
Charles David Roberts, DC
- Chiropractor
- Harriman, TN
National Provider Identifier
1144320656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC000251
- Practice address
- 2497 S Roane St
Suite 260
Harriman, TN 37748-8670 - Phone
- (865) 882-5252
- Fax
- (865) 882-5281
- NPI assigned
- Sep 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC000251 | TN | Primary |
Addresses
Primary practice location
2497 S Roane St
Suite 260
Harriman, TN 37748-8670
Mailing address
2497 S Roane St
Suite 260
Harriman, TN 37748-8670
Phone (865) 882-5252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0014531 | Other | TN | BLUE CROSS& BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070711000486 | TN | Practitioner - Chiropractic | 0345340998 | Practice locations: Harriman, TN |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 1979
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2497 S Roane St
Suite 260
Harriman, TN 37748-8692
Phone (865) 882-5252
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC000251 | TN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144320656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2497 S ROANE ST",
"address_2": "SUITE 260",
"city": "HARRIMAN",
"state": "TN",
"postal_code": "377488670",
"telephone_number": "865-882-5252",
"fax_number": "865-882-5281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2497 S ROANE ST",
"address_2": "SUITE 260",
"city": "HARRIMAN",
"state": "TN",
"postal_code": "377488670",
"telephone_number": "865-882-5252",
"fax_number": "865-882-5281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "CHARLES",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TN",
"license": "DC000251",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS& BLUE SHIELD",
"identifier": "0014531",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harriman, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.