=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912083957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1513 MARKET PLACE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-931-0655
-----------------------------------------------------
Fax | 870-931-0665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1513 MARKET PLACE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-931-0655
-----------------------------------------------------
Fax | 870-931-0665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. KENNETH DEWAYNE EUBANKS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 870-931-0655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | E2241
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1177
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------