Healthcare Provider Details

I. General information

NPI: 1114361425
Provider Name (Legal Business Name): CHRIS ANDREW WHALEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 INTERSTATE 630
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

10709 SAN JOAQUIN VALLEY DR
LITTLE ROCK AR
72212-3633
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number669
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: