MEDICARE: DESTINY SPINE REHABILITATION & ACUPUNCTURE, LLC

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

General Provider Information

NPI Number	:	1790490761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINY SPINE REHABILITATION & ACUPUNCTURE, LLC

Provider Business Mailing Address
First Line	:	2356 N HIGHWAY 7
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71909-9309
Country	:	US
Telephone Number	:	501-356-0655
Fax Number	:	501-984-9822

Provider Business Practice Location Address
First Line	:	2356 N HIGHWAY 7
Second Line	:
City	:	HOT SPRINGS VILLAGE
State	:	AR
Zip	:	71909-9309
Country	:	US
Telephone Number	:	501-356-0655
Fax Number	:	501-984-9822

Authorized Official
Title or Position	:	OWNER
Name	:	ALICE CARDONA
Credential	:	DC
Telephone Number	:	501-356-0655

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	05/26/2023

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