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>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1609940436

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 903-628-2871  Fax: 903-628-0131

Contact information for business:
Tel: 903-628-2871  Fax: 903-628-0131

Registration Information:
NPI: 1609940436
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers

Legacy codes, insurance codes and state license numbers:

BC BS AR9779201


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