Provider Demographics
NPI:1659450302
Name:KILROY, ROBERT ANDREW (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:KILROY
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 1:12401 WILSHIRE BLVD
Mailing Address - Street 2:#104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1085
Mailing Address - Country:US
Mailing Address - Phone:310-451-4888
Mailing Address - Fax:310-442-0524
Practice Address - Street 1:12401 WILSHIRE BLVD
Practice Address - Street 2:#104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1085
Practice Address - Country:US
Practice Address - Phone:310-451-4888
Practice Address - Fax:310-442-0524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor