Active NPI
Michael Carl Roberts, D.C.
- Chiropractor
- Huntingdon, TN
National Provider Identifier
1811061559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC0000001372
- Practice address
- 12745 Lexington St
Huntingdon, TN 38344-3720 - Phone
- (731) 986-2120
- Fax
- (731) 986-3373
- NPI assigned
- Nov 17, 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 | DC0000001372 | TN | Primary |
Addresses
Primary practice location
12745 Lexington St
Huntingdon, TN 38344-3720
Mailing address
12745 Lexington St
Huntingdon, TN 38344-3720
Phone (731) 986-2120
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350042566 | Other | TN | RAILROAD MEDICARE |
| 62-1685843 | Other | TN | TAX ID # |
| 44-40326 | Other | TN | UNITED HEALTHCARE |
| 3813461 | Medicaid | TN | |
| WT2052 | Other | TN | CIGNA |
| 5729484 | Other | TN | AETNA |
| 3062025 | 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 |
|---|---|---|---|---|
| I20121008000339 | TN | Practitioner - Chiropractic | 3678722667 | Practice locations: Huntingdon, TN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC0000001372 | TN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347926400000",
"number": "1811061559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12745 LEXINGTON ST",
"city": "HUNTINGDON",
"state": "TN",
"postal_code": "383443720",
"telephone_number": "731-986-2120",
"fax_number": "731-986-3373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12745 LEXINGTON ST",
"city": "HUNTINGDON",
"state": "TN",
"postal_code": "383443720",
"telephone_number": "731-986-2120",
"fax_number": "731-986-3373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "MICHAEL",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2012-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TN",
"license": "DC0000001372",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "350042566",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "62-1685843",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "44-40326",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3813461",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "WT2052",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5729484",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "3062025",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntingdon, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.