Individual provider Active NPI

Roberta Dawn Damberg, D.C.

  • Chiropractor
  • Auburn, NY
National Provider Identifier
1700903663
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X002894-1 Issued in NY
Practice address
109 South St
Auburn, NY 13021-4837
Phone
(315) 253-8084
Fax
(315) 253-7732
NPI assigned
Mar 24, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X002894-1 NY Primary

Addresses

Primary practice location

109 South St
Auburn, NY 13021-4837

Mailing address

109 South St
Auburn, NY 13021-4837
Phone (315) 253-8084

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111205000027 NY Practitioner - Chiropractic 3678748555 Practice locations: Auburn, NY

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1981
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

109 S St
Auburn, NY 13021

109 S St
Auburn, NY 13021-4837
Phone (315) 253-8084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X002894-1NYMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700903663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 SOUTH ST",
            "city": "AUBURN",
            "state": "NY",
            "postal_code": "130214837",
            "telephone_number": "315-253-8084",
            "fax_number": "315-253-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 SOUTH ST",
            "city": "AUBURN",
            "state": "NY",
            "postal_code": "130214837",
            "telephone_number": "315-253-8084",
            "fax_number": "315-253-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMBERG",
        "first_name": "ROBERTA",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X002894-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, NY

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.

Verify at the official NPI Registry.