Provider Demographics
NPI:1477557288
Name:ROY, JUDITH (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
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 1:4800 MILLERTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2138
Mailing Address - Country:US
Mailing Address - Phone:865-522-6300
Mailing Address - Fax:865-522-2455
Practice Address - Street 1:4800 MILLERTOWN PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2138
Practice Address - Country:US
Practice Address - Phone:865-522-6300
Practice Address - Fax:865-522-2455
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2015-07-20
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TN646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3970617Medicare PIN