Jonny David Roberts Jr., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1661 Issued in LA

Practice address

2163 Gause Blvd W
Ste 4
Slidell, LA 70460-4132

Phone

(504) 662-1544

Fax

(504) 335-0740

NPI assigned

Oct 22, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innate Potential Chiropractic LLC

  • Chiropractor
  • Slidell, LA
  • NPI 1689915183
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1891048344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60154 NINA DR",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704453938",
            "telephone_number": "504-913-3031",
            "fax_number": "504-335-0740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2163 GAUSE BLVD W",
            "address_2": "STE 4",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704604132",
            "telephone_number": "504-662-1544",
            "fax_number": "504-335-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JONNY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-22",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "LA",
            "license": "1661",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "1661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Richert Rizk, CCC-SLP
• Jordan Elaine Roach
• Robert V Shafor, MD
• Alexandra Roberts
• Cory Anthony Roberts, M.D.
• Michelle B Roberts, RN, IBCLC,RLC
• Shana K Roberts, MHS
• Stephanie Roberts, LMT
• Timothy Michael Roberts
• Colleen Robertson

• Chiropractor in Slidell, LA
• Providers in Slidell, LA by specialty
• Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.