Healthcare Provider Details

I. General information

NPI: 1073806444
Provider Name (Legal Business Name): GARRETT J ROY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 BROADWAY ST
SMACKOVER AR
71762-1821
US

IV. Provider business mailing address

PO BOX 86
SMACKOVER AR
71762-0086
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-3100
  • Fax: 501-423-7740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1369
License Number StateAR

VIII. Authorized Official

Name: DR. GARRETT J ROY
Title or Position: OWNER
Credential:
Phone: 870-725-3100