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General NPI Number Information
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NPI Number | 1760837652
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Entity Type | Organization
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Legal Business Name | ARBOR VITAE CHIROPRACTIC INC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 1401 S WALTON BLVD STE 25
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City | BENTONVILLE
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State | AR
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Zip | 72712-6139
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Country | US
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Telephone | 479-208-6766
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Fax | 479-435-7120
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Provider Business Mailing Address
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Address Line | 1401 S WALTON BLVD STE 25
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City | BENTONVILLE
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State | AR
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Zip | 72712-6139
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Country | US
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Telephone | 479-208-6766
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Fax | 479-435-7120
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS NIEMELA
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Credential | DC
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Telephone | 479-208-6766
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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 | 16124
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License Number State | AR
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