=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497415608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITY CHIROPRACTIC & WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2021
-----------------------------------------------------
Last Update Date | 12/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 W TYLER AVE STE A
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-4225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-394-9197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1960 SHADY WIND DR
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38671-9430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-260-8191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | KRISTIE L. DAVIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 870-394-9197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------