Active NPI
Charles Donald Robertson II, D.C.
- Chiropractor
- Sutton, WV
National Provider Identifier
1467534479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 699
- Practice address
- 2258 Sutton LN
Sutton, WV 26601-9717 - Phone
- (304) 750-2092
- Fax
- (304) 750-2093
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 699 | WV | Primary |
Addresses
Primary practice location
2258 Sutton LN
Sutton, WV 26601-9717
Mailing address
2258 Sutton LN
Sutton, WV 26601-9717
Phone (304) 750-2092
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1070496 | Other | WV | BRICKSTREET VENDOR # |
| 699 | Other | WV | STATE LICENSE # |
| 74-318-5632 | Other | WV | TAX I.D. # |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 699 | WV | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253491200000",
"number": "1467534479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2258 SUTTON LN",
"city": "SUTTON",
"state": "WV",
"postal_code": "266019717",
"telephone_number": "304-750-2092",
"fax_number": "304-750-2093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2258 SUTTON LN",
"city": "SUTTON",
"state": "WV",
"postal_code": "266019717",
"telephone_number": "304-750-2092",
"fax_number": "304-750-2093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "CHARLES",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2009-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WV",
"license": "699",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BRICKSTREET VENDOR #",
"identifier": "1070496",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE #",
"identifier": "699",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX I.D. #",
"identifier": "74-318-5632",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sutton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.