Healthcare Provider Details

I. General information

NPI: 1245185248
Provider Name (Legal Business Name): MR. CHAD ALLYN GANNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

2960 SALEM OAKS DR
CONWAY AR
72034-5028
US

V. Phone/Fax

Practice location:
  • Phone: 208-407-5863
  • Fax:
Mailing address:
  • Phone: 208-407-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12484
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: