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General NPI Number Information
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NPI Number | 1013084367
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Entity Type | Organization
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Legal Business Name | CABOT CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 803 W LOCUST ST
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City | CABOT
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State | AR
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Zip | 72023
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Country | US
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Telephone | 501-843-3545
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1120
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City | CABOT
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State | AR
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Zip | 72023
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Country | US
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Telephone | 501-843-3545
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Fax | 501-843-3547
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MRS. BRENDA LEE THIELEMIER
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Credential |
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Telephone | 501-843-3545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1283
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License Number State | AR
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