=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851845895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DILLON QUAYED CRAWFORD D.C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2016
-----------------------------------------------------
Last Update Date | 08/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1803 SW REGIONAL AIRPORT BLVD ST. 9
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-7755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-319-6211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1803 SW REGIONAL AIRPORT BLVD ST. 9
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-7755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-319-6211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 16143
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------