MEDICARE: CHIROPRACTIC WELLNESS CENTER, 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	1435 & 1085	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5G015	OTHER	AR	MEDICARE GROUP
3	DN3101	OTHER	AR	RR MEDICARE-PALMETTO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5G015	OTHER	AR	BLUE CROSS GROUP
4	19689000000	OTHER	AR	QUAL CHOICE GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942369798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	300 S RODNEY PARHAM RD
Second Line	:	SUITE 11
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4747
Country	:	US
Telephone Number	:	501-663-4663
Fax Number	:	501-663-7689

Provider Business Practice Location Address
First Line	:	300 S RODNEY PARHAM RD
Second Line	:	SUITE 11
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4774
Country	:	US
Telephone Number	:	501-663-4663
Fax Number	:	501-663-7689

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. BARBARA CASEY J CASEY
Credential	:
Telephone Number	:	501-663-4663

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	08/07/2013

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