Healthcare Provider Details

I. General information

NPI: 1336363787
Provider Name (Legal Business Name): ROY OTTINGER II DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85220-4010
US

IV. Provider business mailing address

837 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85220-4010
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0991
  • Fax: 480-982-2734
Mailing address:
  • Phone: 480-982-0991
  • Fax: 480-982-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3902
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: