Healthcare Provider Details

I. General information

NPI: 1710347083
Provider Name (Legal Business Name): RESTORATION HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 CHENAL PKWY SUITE 120
LITTLE ROCK AR
72211-2016
US

IV. Provider business mailing address

15400 CHENAL PKWY SUITE 120
LITTLE ROCK AR
72211-2016
US

V. Phone/Fax

Practice location:
  • Phone: 501-400-7700
  • Fax: 501-244-3784
Mailing address:
  • Phone: 501-400-7700
  • Fax: 501-244-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16120
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL BUTLER
Title or Position: OWNER
Credential: DC
Phone: 501-400-7700