MEDICARE: BLACKMON CHIROPRACTIC CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1383	AR

General Provider Information

NPI Number	:	1508850256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKMON CHIROPRACTIC CLINIC, P.A.

Provider Business Mailing Address
First Line	:	7000 CANTRELL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4139
Country	:	US
Telephone Number	:	501-663-4101
Fax Number	:	501-663-7526

Provider Business Practice Location Address
First Line	:	7000 CANTRELL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4139
Country	:	US
Telephone Number	:	501-663-4101
Fax Number	:	501-663-7526

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER ROYSE BLACKMON
Credential	:	D.C.
Telephone Number	:	501-663-4101

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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