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General NPI Number Information
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NPI Number | 1700062924
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Entity Type | Organization
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Legal Business Name | ROBERT A. KILROY, DC A CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 12401 WILSHIRE BLVD #104
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City | LOS ANGELES
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State | CA
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Zip | 90025-1085
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Country | US
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Telephone | 310-451-4888
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Fax | 310-442-0524
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Provider Business Mailing Address
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Address Line | 12401 WILSHIRE BLVD #104
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City | LOS ANGELES
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State | CA
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Zip | 90025-1085
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Country | US
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Telephone | 310-451-4888
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Fax | 310-442-0524
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Authorized Official
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Title or Position | PRES
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Name | ROBERT ANDREW KILROY
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Credential | D.C.
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Telephone | 310-451-4888
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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 | 19179
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License Number State | CA
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