=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114161965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC TOUCH MEDICAL CENTERS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2009
-----------------------------------------------------
Last Update Date | 02/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S UNIVERSITY AVE STE 515
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-280-0250
-----------------------------------------------------
Fax | 501-280-0260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 3554
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-658-9000
-----------------------------------------------------
Fax | 501-280-0260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. KENDALL LEVELL WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-658-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1681
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------