Provider Demographics
NPI:1518273416
Name:ROYAL, KRISTOPHER WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:WILLIAM
Last Name:ROYAL
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 1:2716 PACIFIC AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8804
Mailing Address - Country:US
Mailing Address - Phone:360-943-8250
Mailing Address - Fax:360-943-0473
Practice Address - Street 1:2716 PACIFIC AVE SE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-8804
Practice Address - Country:US
Practice Address - Phone:360-943-8250
Practice Address - Fax:360-943-0473
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60176210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8901290Medicare UPIN