Healthcare Provider Details

I. General information

NPI: 1366421547
Provider Name (Legal Business Name): SPINAL TRAUMA RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720A STROZIER LN
BARLING AR
72923-1735
US

IV. Provider business mailing address

PO BOX 23601
BARLING AR
72923-0601
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-0369
  • Fax: 479-783-0419
Mailing address:
  • Phone: 479-783-0369
  • Fax: 479-783-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1276
License Number StateAR

VIII. Authorized Official

Name: DR. STEPHEN MARK MATTHEW
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 479-783-0369