Healthcare Provider Details

I. General information

NPI: 1750432555
Provider Name (Legal Business Name): SPRING RIVER CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S MAIN ST SUITE #1
MAMMOTH SPRING AR
72554-7423
US

IV. Provider business mailing address

PO BOX 157
MAMMOTH SPRING AR
72554-0157
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3355
  • Fax:
Mailing address:
  • Phone: 870-625-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1368
License Number StateAR

VIII. Authorized Official

Name: DR. DOUGLAS BRENT GARRISON
Title or Position: OWNER
Credential: D.C.
Phone: 870-625-3355