Healthcare Provider Details

I. General information

NPI: 1356411276
Provider Name (Legal Business Name): TWIN LAKES CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 HIGHWAY 178 WEST
LAKEVIEW AR
72642
US

IV. Provider business mailing address

PO BOX 148
LAKEVIEW AR
72642-0148
US

V. Phone/Fax

Practice location:
  • Phone: 870-431-8900
  • Fax: 870-431-8810
Mailing address:
  • Phone: 870-431-8900
  • Fax: 870-431-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number904
License Number StateAR

VIII. Authorized Official

Name: DR. MARK LUDEAN UNGERANK
Title or Position: OWNER
Credential: DC
Phone: 870-431-8900