Healthcare Provider Details

I. General information

NPI: 1730505876
Provider Name (Legal Business Name): BOONEVILLE CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 WEST 6TH STREET
BOONEVILLE AR
72927
US

IV. Provider business mailing address

.P.O BOX 597
BOONEVILLE AR
72927
US

V. Phone/Fax

Practice location:
  • Phone: 479-675-4253
  • Fax:
Mailing address:
  • Phone: 479-675-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1290
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1290
License Number StateAR

VIII. Authorized Official

Name: DR. JAMES A. HALE
Title or Position: PRES.
Credential: D.C.
Phone: 479-675-4253