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General NPI Number Information
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NPI Number | 1437227006
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Entity Type | Organization
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Legal Business Name | LAWRENCE COUNTY CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 219 SOUTHWEST 2ND STREET
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-2335
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Country | US
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Telephone | 870-886-2603
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Fax | 870-886-2623
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Provider Business Mailing Address
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Address Line | PO BOX 896
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-0896
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Country | US
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Telephone | 870-886-2603
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Fax | 870-886-2623
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT L SHACKELFORD II
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Credential | D.C.
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Telephone | 870-886-2603
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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 | 998
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License Number State | AR
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