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General NPI Number Information
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NPI Number | 1194822387
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Entity Type | Organization
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Legal Business Name | ARKANSAS VALLEY CHIROPRACTIC CLINIC,P.A.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1386 STATE HIGHWAY 22 W
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City | DARDANELLE
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State | AR
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Zip | 72834-2915
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Country | US
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Telephone | 479-229-2553
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Fax | 479-229-2554
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Provider Business Mailing Address
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Address Line | PO BOX 117
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City | DARDANELLE
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State | AR
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Zip | 72834-0117
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Country | US
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Telephone | 479-229-2553
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Fax | 479-229-2554
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL W. PEARSON
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Credential | D.C.
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Telephone | 479-229-2553
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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 | 995
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License Number State | AR
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