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Individual

DR. CHARLES DONALD ROBERTSON II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
2258 SUTTON LN, SUTTON, WV 26601-9717
(304) 750-2092
(304) 750-2093
Mailing address
2258 SUTTON LN, SUTTON, WV 26601-9717
(304) 750-2092
(304) 750-2093

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
699
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1070496
BRICKSTREET VENDOR #
WV
01
699
STATE LICENSE #
WV
01
74-318-5632
TAX I.D. #
WV
Enumeration date
10/19/2006
Last updated
09/21/2009
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