MEDICARE: CHANDLER CHIROPRACTIC 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	111NI0013X	Independent Medical Examiner Chiropractor	1384	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5T106	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1689893760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDLER CHIROPRACTIC P.A.

Provider Business Mailing Address
First Line	:	2023 E. MAIN ST.
Second Line	:	STE. C
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-5504
Country	:	US
Telephone Number	:	479-524-5555
Fax Number	:	479-524-8054

Provider Business Practice Location Address
First Line	:	2023 E. MAIN ST.
Second Line	:	STE. C
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-5504
Country	:	US
Telephone Number	:	479-524-5555
Fax Number	:	479-524-8054

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. DENISE A CHANDLER
Credential	:	DC
Telephone Number	:	479-524-5555

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/27/2010

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