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General NPI Number Information
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NPI Number | 1699856872
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Entity Type | Organization
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Legal Business Name | GEORGE CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1718 N FALLS BLVD
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City | WYNNE
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State | AR
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Zip | 72396-0498
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Country | US
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Telephone | 870-238-8707
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Fax | 870-238-8711
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Provider Business Mailing Address
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Address Line | PO BOX 498 1718 N FALLS BLVD
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City | WYNNE
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State | AR
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Zip | 72396-0498
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Country | US
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Telephone | 870-238-8707
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Fax | 870-238-8711
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. KENNETH DEWAYNE GEORGE
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Credential | D.C.
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Telephone | 870-238-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1452
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License Number State | AR
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