Healthcare Provider Details

I. General information

NPI: 1922207828
Provider Name (Legal Business Name): ESTES CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 NW 2ND ST
BENTONVILLE AR
72712-5232
US

IV. Provider business mailing address

113 NW 2ND ST
BENTONVILLE AR
72712-5232
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-2273
  • Fax: 479-271-2109
Mailing address:
  • Phone: 479-271-2273
  • Fax: 479-271-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number#1256
License Number StateAR

VIII. Authorized Official

Name: MR. MARK ESTES
Title or Position: OWNER
Credential: D. C.
Phone: 479-271-2273