Active NPI
Loren Keith Roberts, D.C.
- Internist Chiropractor
- Novato, CA
National Provider Identifier
1376553248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- 20766
- Practice address
- 863 Grant Ave
Suite a
Novato, CA 94945-3239 - Phone
- (415) 892-0983
- Fax
- (415) 897-4185
- NPI assigned
- Aug 9, 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 |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | 20766 | CA | Primary |
Addresses
Primary practice location
863 Grant Ave
Suite a
Novato, CA 94945-3239
Mailing address
863 Grant Ave
Suite a
Novato, CA 94945-3239
Phone (415) 892-0983
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20766 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331510400000",
"number": "1376553248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "863 GRANT AVE",
"address_2": "SUITE A",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453239",
"telephone_number": "415-892-0983",
"fax_number": "415-897-4185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "863 GRANT AVE",
"address_2": "SUITE A",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453239",
"telephone_number": "415-892-0983",
"fax_number": "415-897-4185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "LOREN",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2012-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "CA",
"license": "20766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.