Provider Demographics
NPI:1386709467
Name:HILLGARTNER, ROY J (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:J
Last Name:HILLGARTNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:J
Other - Last Name:HILLGARTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:14615 MANCHESTER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3790
Mailing Address - Country:US
Mailing Address - Phone:636-391-0424
Mailing Address - Fax:636-391-0437
Practice Address - Street 1:14615 MANCHESTER RD STE 104
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3790
Practice Address - Country:US
Practice Address - Phone:636-391-0424
Practice Address - Fax:636-391-0437
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42929Medicare UPIN
MO000030027Medicare ID - Type Unspecified