Healthcare Provider Details

I. General information

NPI: 1780381053
Provider Name (Legal Business Name): PCM CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMMERCE DR STE B
MAUMELLE AR
72113-6708
US

IV. Provider business mailing address

201 COMMERCE DR STE B
MAUMELLE AR
72113-6708
US

V. Phone/Fax

Practice location:
  • Phone: 501-333-9330
  • Fax: 501-333-9335
Mailing address:
  • Phone: 501-333-9330
  • Fax: 501-333-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY CHANDLER
Title or Position: PRESIDENT
Credential: DC
Phone: 870-307-4798