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General NPI Number Information
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NPI Number | 1043908171
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Entity Type | Organization
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Legal Business Name | POWER SPINE & SPORT PA
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2655 DONAGHEY AVE STE 101
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City | CONWAY
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State | AR
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Zip | 72032-2344
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Country | US
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Telephone | 501-459-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 S SAINT LOUIS ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7223
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Country | US
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Telephone | 870-307-4798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY CHANDLER
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Credential | DC
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Telephone | 870-307-4798
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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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