Provider Demographics
NPI:1720194707
Name:DAMSER, ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:DAMSER
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 1:191 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3764
Mailing Address - Country:US
Mailing Address - Phone:949-548-2350
Mailing Address - Fax:949-548-0717
Practice Address - Street 1:191 E 16TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3764
Practice Address - Country:US
Practice Address - Phone:949-548-2350
Practice Address - Fax:949-548-0717
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17432OtherSTATE CHIROLICENSE NUMBER