Healthcare Provider Details

I. General information

NPI: 1760461933
Provider Name (Legal Business Name): NATURAL STATE HEALING ARTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 E HUNTSVILLE RD
FAYETTEVILLE AR
72701-6127
US

IV. Provider business mailing address

534 E HUNTSVILLE RD
FAYETTEVILLE AR
72701-6127
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-4325
  • Fax:
Mailing address:
  • Phone: 479-582-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1430
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM 029
License Number StateAR

VIII. Authorized Official

Name: DR. LISA FOGEL
Title or Position: PRESIDENT
Credential: DOM
Phone: 479-582-4325