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General NPI Number Information
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NPI Number | 1043805708
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Entity Type | Organization
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Legal Business Name | JRJ FAMILY ENTERPRISES LLC
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 1401 SW 14TH ST STE 9
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City | BENTONVILLE
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State | AR
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Zip | 72712-3679
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Country | US
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Telephone | 479-595-8726
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Fax | 479-282-0444
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Provider Business Mailing Address
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Address Line | 1401 SW 14TH ST STE 99
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City | BENTONVILLE
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State | AR
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Zip | 72712-3634
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Country | US
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Telephone | 501-454-9961
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JEREMY RAY JOHNSON
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Credential | D.C.
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Telephone | 501-454-9961
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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 |
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License Number State |
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