Healthcare Provider Details

I. General information

NPI: 1760410484
Provider Name (Legal Business Name): DOUGLAS BRENT GARRISON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BETHEL AVE
MAMMOTH SPRING AR
72554-0157
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: 870-625-3356
Mailing address:
  • Phone: 870-625-3355
  • Fax: 870-625-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1368
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006314
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: