Healthcare Provider Details

I. General information

NPI: 1730852864
Provider Name (Legal Business Name): PIKE SPINE AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 PIKE AVE
NORTH LITTLE ROCK AR
72114-1926
US

IV. Provider business mailing address

2649 PIKE AVE
NORTH LITTLE ROCK AR
72114-1926
US

V. Phone/Fax

Practice location:
  • Phone: 501-904-1618
  • Fax: 501-414-0089
Mailing address:
  • Phone: 501-904-1618
  • Fax: 501-414-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN VINCENT
Title or Position: CREDENTIALING
Credential:
Phone: 501-626-8279