Provider Demographics
NPI:1447577416
Name:ROYBAL, JUAN RICK III (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RICK
Last Name:ROYBAL
Suffix:III
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 1:11030 N TATUM BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-494-3037
Mailing Address - Fax:
Practice Address - Street 1:11030 N TATUM BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-494-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor