Provider Demographics
NPI:1881865418
Name:DE ROY, JOHN WARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:DE ROY
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 1:120 HICKORY ST
Mailing Address - Street 2:STE. B.
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5908
Mailing Address - Country:US
Mailing Address - Phone:415-864-7860
Mailing Address - Fax:415-864-6228
Practice Address - Street 1:120 HICKORY ST
Practice Address - Street 2:STE. B.
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5908
Practice Address - Country:US
Practice Address - Phone:415-864-7860
Practice Address - Fax:415-864-6228
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0157801Medicare PIN