Healthcare Provider Details

I. General information

NPI: 1982162103
Provider Name (Legal Business Name): CAITLIN HALEY CORONA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NEW ST
QUITMAN AR
72131-8607
US

IV. Provider business mailing address

PO BOX 335
QUITMAN AR
72131-0335
US

V. Phone/Fax

Practice location:
  • Phone: 501-589-2222
  • Fax: 501-589-2222
Mailing address:
  • Phone: 501-589-2222
  • Fax: 501-589-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number16208
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: