Healthcare Provider Details

I. General information

NPI: 1235603200
Provider Name (Legal Business Name): ARKANSAS HOLISTIC HEALTH CARE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2618 MLK JR BLVD
FAYETTEVILLE AR
72701
US

IV. Provider business mailing address

2618 MLK JR BLVD
FAYETTEVILLE AR
72701
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-7755
  • Fax: 479-521-6965
Mailing address:
  • Phone: 479-521-7755
  • Fax: 479-521-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JORDAN DANIEL TRAVIS
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 479-521-7755