Provider Demographics
NPI:1992463525
Name:ROY, PETER (DC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ROY
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 1:34 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2822
Mailing Address - Country:US
Mailing Address - Phone:636-356-5557
Mailing Address - Fax:636-775-2659
Practice Address - Street 1:34 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2822
Practice Address - Country:US
Practice Address - Phone:636-356-5557
Practice Address - Fax:636-775-2659
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor