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General NPI Number Information
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NPI Number | 1487466959
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Entity Type | Individual
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Provider Name | JACOB CRUMPLER DC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1344 BENTON ST STE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-6325
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Country | US
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Telephone | 501-762-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 163 RAINSONG DR
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City | FARMINGTON
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State | AR
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Zip | 72730-8623
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Country | US
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Telephone | 501-762-2558
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Fax |
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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 | 12428
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License Number State | AR
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