Provider Demographics
NPI:1275571853
Name:ROY, GARRETT J (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:J
Last Name:ROY
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 1:608 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-1821
Mailing Address - Country:US
Mailing Address - Phone:870-725-1112
Mailing Address - Fax:
Practice Address - Street 1:14051 EAST INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-1821
Practice Address - Country:US
Practice Address - Phone:704-626-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4509111N00000X
SC3953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR71-0805923OtherTAX ID
AR350044294OtherRAILROAD MEDICARE
AR5S996Medicare ID - Type Unspecified
AR71-0805923OtherTAX ID