Active NPI
Douglas Wayne Roberts, D.C.
- Chiropractor
- Modesto, CA
National Provider Identifier
1922180900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 122610
- Practice address
- 1136 Tully Rd Ste 1
Modesto, CA 95350-4994 - Phone
- (209) 577-1274
- Fax
- (209) 577-2243
- NPI assigned
- Oct 19, 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 | 122610 | CA | Primary |
Addresses
Primary practice location
1136 Tully Rd Ste 1
Modesto, CA 95350-4994
Mailing address
1136 Tully Rd Ste 1
Modesto, CA 95350-4994
Phone (209) 577-1274
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122610 | CA | MD | Clinical Social Worker |
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": "1203465600000",
"number": "1922180900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1136 TULLY RD STE 1",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504994",
"telephone_number": "209-577-1274",
"fax_number": "209-577-2243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1136 TULLY RD STE 1",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504994",
"telephone_number": "209-577-1274",
"fax_number": "209-577-2243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "DOUGLAS",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2008-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "122610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.