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General NPI Number Information
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NPI Number | 1538124797
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Entity Type | Organization
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Legal Business Name | TICE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1211 HIGHWAY 133 N
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City | CROSSETT
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State | AR
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Zip | 71635-4843
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Country | US
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Telephone | 870-364-9540
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Fax | 870-364-9840
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Provider Business Mailing Address
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Address Line | 1211 HIGHWAY 133 N
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City | CROSSETT
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State | AR
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Zip | 71635-4843
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Country | US
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Telephone | 870-364-9540
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Fax | 870-364-9840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN D TICE
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Credential | DC
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Telephone | 870-364-9540
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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 |
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License Number State | AR
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