Provider Demographics
NPI:1053951475
Name:ROBERSON, TAWANA NAYDEAN (DC)
Entity type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:NAYDEAN
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 SUMMERS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8388
Mailing Address - Country:US
Mailing Address - Phone:803-354-8281
Mailing Address - Fax:
Practice Address - Street 1:2638 TWO NOTCH RD SUITE 204 UNIT 11
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-995-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.4526111N00000X
SC4526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty