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General NPI Number Information
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NPI Number | 1275098493
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Entity Type | Individual
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Provider Name | AVERY MARIE ROY DC
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 150 E TRAVELERS TRL STE B
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City | BURNSVILLE
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State | MN
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Zip | 55337-6890
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Country | US
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Telephone | 651-463-8222
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Fax | 651-463-8228
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Provider Business Mailing Address
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Address Line | 14030 CHESTNUT DR APT 109
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-1685
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Country | US
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Telephone | 605-999-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6596
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License Number State | MN
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