Provider Demographics
NPI:1245306687
Name:ROYBAL, MARIO D (DC)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:D
Last Name:ROYBAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:DION
Other - Last Name:ROYBAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1203 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6640
Mailing Address - Country:US
Mailing Address - Phone:509-328-7575
Mailing Address - Fax:509-328-5031
Practice Address - Street 1:1203 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6640
Practice Address - Country:US
Practice Address - Phone:509-328-7575
Practice Address - Fax:509-328-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026888Medicaid
WA2026888Medicaid
WAU68168Medicare UPIN