Provider Demographics
NPI:1124197652
Name:ROYSTON, J FULLER (DC)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:FULLER
Last Name:ROYSTON
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 1:12201 N NC HIGHWAY 150 STE 4
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9731
Mailing Address - Country:US
Mailing Address - Phone:336-775-7600
Mailing Address - Fax:336-775-7610
Practice Address - Street 1:12201 N NC HIGHWAY 150 STE 4
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9731
Practice Address - Country:US
Practice Address - Phone:336-775-7600
Practice Address - Fax:336-775-7610
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor