Provider Demographics
NPI:1780999896
Name:MCDONALD, ROY DEWAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:DEWAYNE
Last Name:MCDONALD
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 1:2507 S.W. 59TH ST.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119
Mailing Address - Country:US
Mailing Address - Phone:405-312-2912
Mailing Address - Fax:
Practice Address - Street 1:2507 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-6613
Practice Address - Country:US
Practice Address - Phone:405-312-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor