Provider Demographics
NPI:1194718585
Name:ROYER, BRYAN D (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:ROYER
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 1:5800 MONROE ST A11
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2363
Mailing Address - Country:US
Mailing Address - Phone:419-517-5055
Mailing Address - Fax:419-571-1307
Practice Address - Street 1:5800 MONROE ST A11
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2363
Practice Address - Country:US
Practice Address - Phone:419-517-5055
Practice Address - Fax:419-517-1307
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-3582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV05147Medicare UPIN
4158771Medicare PIN