Provider Demographics
NPI:1336363787
Name:OTTINGER, ROY II (DC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:OTTINGER
Suffix:II
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 1:837 W SUPERSTITION BLVD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-4010
Mailing Address - Country:US
Mailing Address - Phone:480-982-0991
Mailing Address - Fax:480-982-2734
Practice Address - Street 1:837 W SUPERSTITION BLVD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-4010
Practice Address - Country:US
Practice Address - Phone:480-982-0991
Practice Address - Fax:480-982-2734
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC3902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZ6989Medicare ID - Type Unspecified
U10322Medicare UPIN