Healthcare Provider Details

I. General information

NPI: 1174575195
Provider Name (Legal Business Name): RONALD D ERWIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 VINE ST
BATESVILLE AR
72501-3526
US

IV. Provider business mailing address

1175 VINE ST
BATESVILLE AR
72501-3526
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-4177
  • Fax: 870-793-6433
Mailing address:
  • Phone: 870-793-4177
  • Fax: 870-793-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number858
License Number StateAR

VIII. Authorized Official

Name: DR. RONALD D ERWIN
Title or Position: OWNER/CHRIPORACTOR
Credential: DC
Phone: 870-793-4177