Provider Demographics
NPI:1982127072
Name:WILKINS, ROY DOYLE (DC, DABCN)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:DOYLE
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DC, DABCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 AUTUMNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-6994
Mailing Address - Country:US
Mailing Address - Phone:928-368-3977
Mailing Address - Fax:928-358-4601
Practice Address - Street 1:1553 AUTUMNWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-6994
Practice Address - Country:US
Practice Address - Phone:928-368-3965
Practice Address - Fax:928-358-4601
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3836111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC3836OtherCASH