Provider Demographics
NPI:1609153543
Name:ROY, DAVID JASON (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JASON
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 1:3315 MAUCH CHUNK RD
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-2074
Mailing Address - Country:US
Mailing Address - Phone:610-769-7700
Mailing Address - Fax:610-769-4701
Practice Address - Street 1:3315 MAUCH CHUNK RD
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-2074
Practice Address - Country:US
Practice Address - Phone:610-769-7700
Practice Address - Fax:610-769-4701
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor