Healthcare Provider Details

I. General information

NPI: 1588772677
Provider Name (Legal Business Name): ENGELHOVEN CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E KIEHL AVE
SHERWOOD AR
72120-3041
US

IV. Provider business mailing address

1409 E KIEHL AVE
SHERWOOD AR
72120-3041
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-7902
  • Fax: 501-835-7908
Mailing address:
  • Phone: 501-835-7902
  • Fax: 501-835-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number883
License Number StateAR

VIII. Authorized Official

Name: MAX ED ENGELHOVEN
Title or Position: OWNER
Credential: DC
Phone: 501-835-7902