Healthcare Provider Details

I. General information

NPI: 1194822387
Provider Name (Legal Business Name): ARKANSAS VALLEY CHIROPRACTIC CLINIC,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 STATE HIGHWAY 22 W
DARDANELLE AR
72834-2915
US

IV. Provider business mailing address

PO BOX 117
DARDANELLE AR
72834-0117
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-2553
  • Fax: 479-229-2554
Mailing address:
  • Phone: 479-229-2553
  • Fax: 479-229-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number995
License Number StateAR

VIII. Authorized Official

Name: RUSSELL W. PEARSON
Title or Position: OWNER
Credential: D.C.
Phone: 479-229-2553