Healthcare Provider Details

I. General information

NPI: 1114123940
Provider Name (Legal Business Name): HEALTH CHOICE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST SUITE 9
CONWAY AR
72032-5446
US

IV. Provider business mailing address

611 COURT ST SUITE 9
CONWAY AR
72032-5446
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-4894
  • Fax: 501-358-4891
Mailing address:
  • Phone: 501-358-4894
  • Fax: 501-358-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1569
License Number StateAR

VIII. Authorized Official

Name: DR. THOMAS EDWARD CARLYLE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 501-358-4894