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General NPI Number Information
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NPI Number | 1275846784
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Entity Type | Organization
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Legal Business Name | TIMELESS FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 116 MAXWELL ST.
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City | CLINTON
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State | AR
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Zip | 72031
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Country | US
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Telephone | 501-745-2460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | CLINTON
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State | AR
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Zip | 72031-0438
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Country | US
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Telephone | 501-745-2460
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JENNIFER RENEE ROBERSON
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Credential | D.C.
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Telephone | 501-253-0649
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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 | 15714
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License Number State | AR
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