Organization Active NPI

Dr Rob Robertson DC LLC

  • Chiropractor
  • Hannibal, MO
National Provider Identifier
1407993884
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2004022080 Issued in MO
Legal business name
DR ROB ROBERTSON DC LLC
Practice address
2918 Saint Marys Ave
Hannibal, MO 63401-3715
Phone
(573) 221-5555
Fax
(573) 221-5765
NPI assigned
Feb 1, 2007
Last updated
Feb 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Robbie Robertson, D.C.NPI 1891898359
Title
Chiropractor
Phone
(573) 221-5555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2004022080 MO Primary

Addresses

Primary practice location

2918 Saint Marys Ave
Hannibal, MO 63401-3715

Mailing address

2918 Saint Marys Ave
Hannibal, MO 63401-3715
Phone (573) 221-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070213000583 MO Part B Supplier - Clinic/Group Practice 8426050931 Receives reassigned benefits from 1 practitioner
Practice locations: Hannibal, MO

National Provider Directory

National Provider Directory

Locations

200 S Madison St
Pittsfield, IL 62363
Phone (217) 285-5700

977 W Washington St
Pittsfield, IL 62363
Phone (217) 285-5700

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1407993884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 SAINT MARYS AVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634013715",
            "telephone_number": "573-221-5555",
            "fax_number": "573-221-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 SAINT MARYS AVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634013715",
            "telephone_number": "573-221-5555",
            "fax_number": "573-221-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ROB ROBERTSON DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ROBBIE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "573-221-5555",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2004022080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.