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General NPI Number Information
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NPI Number | 1669579892
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Entity Type | Organization
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Legal Business Name | MYSHKA CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 SOUTH COLLEGE AVE SUITE A
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City | FAYETTEVILLE
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State | AR
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Zip | 72701
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Country | US
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Telephone | 479-442-0676
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Fax | 479-442-8066
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Provider Business Mailing Address
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Address Line | 114 SOUTH COLLEGE AVE SUITE A
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City | FAYETTEVILLE
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State | AR
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Zip | 72701
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Country | US
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Telephone | 479-442-0676
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Fax | 479-442-8066
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES EDWIN MYSHKA
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Credential | DC
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Telephone | 479-442-0676
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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 | 1091
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License Number State | AR
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