Healthcare Provider Details

I. General information

NPI: 1912083957
Provider Name (Legal Business Name): INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 MARKET PLACE
JONESBORO AR
72401
US

IV. Provider business mailing address

1513 MARKET PLACE
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-931-0655
  • Fax: 870-931-0665
Mailing address:
  • Phone: 870-931-0655
  • Fax: 870-931-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1177
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE2241
License Number StateAR

VIII. Authorized Official

Name: DR. KENNETH DEWAYNE EUBANKS
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 870-931-0655