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General NPI Number Information
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NPI Number | 1356411276
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Entity Type | Organization
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Legal Business Name | TWIN LAKES CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 4898 HIGHWAY 178 WEST
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City | LAKEVIEW
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State | AR
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Zip | 72642
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Country | US
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Telephone | 870-431-8900
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Fax | 870-431-8810
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | LAKEVIEW
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State | AR
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Zip | 72642-0148
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Country | US
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Telephone | 870-431-8900
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Fax | 870-431-8810
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK LUDEAN UNGERANK
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Credential | DC
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Telephone | 870-431-8900
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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 | 904
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License Number State | AR
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