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General NPI Number Information
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NPI Number | 1063677268
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Entity Type | Organization
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Legal Business Name | NESTERENKO SPECIFIC CHIROPRACTIC, INC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 13601 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3146
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Country | US
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Telephone | 501-223-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 13601 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3146
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Country | US
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Telephone | 501-223-5130
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | DR. PAUL ANTHONY NESTERENKO
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Credential | D.C.
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Telephone | 501-223-5130
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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 | 1342
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License Number State | AR
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