Individual provider Active NPI

Matthew Dale Roberson, DC

  • Chiropractor
  • Tyler, TX
National Provider Identifier
1962397257
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
14307 Issued in TX
Practice address
310 W Rusk St
Tyler, TX 75701-1513
Phone
(903) 515-5535
NPI assigned
Jun 9, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 14307 TX Primary

Addresses

Primary practice location

310 W Rusk St
Tyler, TX 75701-1513

Mailing address

PO Box 7215
Tyler, TX 75711-7215
Phone (903) 515-5535

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251028003260 TX Practitioner - Chiropractic 6901395268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Tyler, TX 75711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14307TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Roberson Chiropractic PLLC Chiropractor CurrentSince Oct 10, 2025 Accepting new patients
Shepherd'S Flock Health Services, LLC CurrentSince Oct 21, 2025 Accepting new patients

Locations

310 W Rusk St
Tyler, TX 75701
Phone (903) 515-5535

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1962397257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7215",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757117215",
            "telephone_number": "903-515-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W RUSK ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011513",
            "telephone_number": "903-515-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "MATTHEW",
        "middle_name": "DALE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "14307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.