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General NPI Number Information
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NPI Number | 1821258146
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Entity Type | Organization
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Legal Business Name | GENERATIONS CHIROPRACTIC WELLNESS CENTER
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 1422 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1914
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Country | US
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Telephone | 479-442-2755
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Fax | 479-442-2825
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Provider Business Mailing Address
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Address Line | 1422 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1914
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. AMANDA NICOLE WARREN
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Credential |
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Telephone | 479-442-2755
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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 |
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