Healthcare Provider Details

I. General information

NPI: 1588625412
Provider Name (Legal Business Name): SCHLUTERMAN NEUROLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ADA AVE
CONWAY AR
72034-4985
US

IV. Provider business mailing address

2200 ADA AVE
CONWAY AR
72034-4986
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-0352
  • Fax: 501-932-0354
Mailing address:
  • Phone: 501-932-0352
  • Fax: 501-932-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberE3984
License Number StateAR

VIII. Authorized Official

Name: DR. KEITH O SCHLUTERMAN
Title or Position: OWNER
Credential: MD
Phone: 501-932-0352