Healthcare Provider Details

I. General information

NPI: 1366632887
Provider Name (Legal Business Name): HEALTH MANAGEMENT OF ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

IV. Provider business mailing address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

V. Phone/Fax

Practice location:
  • Phone: 501-374-1153
  • Fax: 501-374-6213
Mailing address:
  • Phone: 501-374-1153
  • Fax: 501-374-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN FREDERICK BENNETT
Title or Position: OWNER
Credential: DC
Phone: 501-374-1153