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General NPI Number Information
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NPI Number | 1346471661
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Entity Type | Individual
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Provider Name | REX PAUL BRADY DECLERK D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 12120 COLONEL GLENN RD STE 6200
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City | LITTLE ROCK
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State | AR
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Zip | 72210-2370
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Country | US
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Telephone | 501-313-2844
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Fax | 501-325-3754
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Provider Business Mailing Address
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Address Line | 12120 COLONEL GLENN RD STE 6200
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City | LITTLE ROCK
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State | AR
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Zip | 72210-2370
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Country | US
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Telephone | 501-313-2844
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Fax | 501-325-3754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 15639
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License Number State | AR
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