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General NPI Number Information
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NPI Number | 1184103376
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Entity Type | Organization
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Legal Business Name | PERRY COUNTY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 130 HOUSTON AVE
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City | PERRYVILLE
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State | AR
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Zip | 72126-9451
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Country | US
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Telephone | 501-889-5555
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Fax | 501-851-6495
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Provider Business Mailing Address
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Address Line | 103 PARK DR
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City | MAUMELLE
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State | AR
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Zip | 72113-7407
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Country | US
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Telephone | 501-851-6685
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Fax | 501-851-6495
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Authorized Official
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Title or Position | CHIROPRACTOR/PARTNER
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Name | DR. TRAY ROBERT FOWLER
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Credential | D.C.
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Telephone | 214-632-9022
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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 | 16033
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License Number State | AR
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