Provider Demographics
NPI:1053695411
Name:ROYAL CHIROPRACTIC PC
Entity type:Organization
Organization Name:ROYAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHAVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-334-5500
Mailing Address - Street 1:530 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1607
Mailing Address - Country:US
Mailing Address - Phone:248-334-5500
Mailing Address - Fax:248-338-0500
Practice Address - Street 1:530 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1607
Practice Address - Country:US
Practice Address - Phone:248-334-5500
Practice Address - Fax:248-338-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMO004919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty