Healthcare Provider Details

I. General information

NPI: 1114800893
Provider Name (Legal Business Name): CHANEY ALLEN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9818 US-62
VIOLA AR
72583
US

IV. Provider business mailing address

95 CIRCLE DR
EVENING SHADE AR
72532-9322
US

V. Phone/Fax

Practice location:
  • Phone: 870-539-9969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5053
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: