Healthcare Provider Details

I. General information

NPI: 1881367803
Provider Name (Legal Business Name): SAMUEL D CATES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 N SHILOH DR STE 2A
FAYETTEVILLE AR
72703-4427
US

IV. Provider business mailing address

3931 N SHILOH DR STE 2A
FAYETTEVILLE AR
72703-4427
US

V. Phone/Fax

Practice location:
  • Phone: 479-530-5470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number16296
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: