Healthcare Provider Details

I. General information

NPI: 1225025778
Provider Name (Legal Business Name): ERIC E CARSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/02/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N GEORGE ST.
MOUNT IDA AR
71957
US

IV. Provider business mailing address

132 MEYERS CREEK RD
ROYAL AR
71968-9304
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-0172
  • Fax: 501-701-4050
Mailing address:
  • Phone: 870-867-0172
  • Fax: 501-701-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1317
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: