Provider Demographics
NPI:1477995587
Name:WITHERS, ROY REGAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:REGAN
Last Name:WITHERS
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 1:4418 VINELAND AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3457
Mailing Address - Country:US
Mailing Address - Phone:818-275-2243
Mailing Address - Fax:818-980-3221
Practice Address - Street 1:4418 VINELAND AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3457
Practice Address - Country:US
Practice Address - Phone:818-275-2243
Practice Address - Fax:818-980-3221
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor