Provider Demographics
NPI:1225093164
Name:ROY, ANDREW JON (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JON
Last Name:ROY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N TYLER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4905
Mailing Address - Country:US
Mailing Address - Phone:316-942-5335
Mailing Address - Fax:316-942-5442
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4905
Practice Address - Country:US
Practice Address - Phone:316-942-5335
Practice Address - Fax:316-942-5442
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059974001Medicare PIN
KSU69437Medicare UPIN