Provider Demographics
NPI:1275098493
Name:ROY, AVERY MARIE (DC)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:MARIE
Last Name:ROY
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 1:14030 CHESTNUT DR APT 109
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1685
Mailing Address - Country:US
Mailing Address - Phone:605-999-8603
Mailing Address - Fax:
Practice Address - Street 1:150 E TRAVELERS TRL STE B
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6890
Practice Address - Country:US
Practice Address - Phone:651-463-8222
Practice Address - Fax:651-463-8228
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor