Provider Demographics
NPI:1720163702
Name:RESCO, ROYCE R (DC)
Entity Type:Individual
Prefix:
First Name:ROYCE
Middle Name:R
Last Name:RESCO
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 1:1910 M ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2207
Mailing Address - Country:US
Mailing Address - Phone:785-527-7000
Mailing Address - Fax:785-527-7001
Practice Address - Street 1:1910 M ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2207
Practice Address - Country:US
Practice Address - Phone:785-527-7000
Practice Address - Fax:785-527-7001
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS62412OtherBCBS
KS062412Medicare PIN