Healthcare Provider Details

I. General information

NPI: 1023350733
Provider Name (Legal Business Name): JEREMY UNGERANK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 BILL FOSTER MEMORIAL HWY STE F
CABOT AR
72023-7221
US

IV. Provider business mailing address

365 HEFFNER RD
AUSTIN AR
72007-8810
US

V. Phone/Fax

Practice location:
  • Phone: 501-831-4425
  • Fax: 501-941-4424
Mailing address:
  • Phone: 501-831-4425
  • Fax: 501-941-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: