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General NPI Number Information
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NPI Number | 1922370113
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Entity Type | Organization
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Legal Business Name | PEREGRINE HEALTH SERVICES
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 2218 RACE ST
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City | JONESBORO
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State | AR
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Zip | 72401-7217
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Country | US
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Telephone | 870-935-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 RACE ST
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City | JONESBORO
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State | AR
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Zip | 72401-7217
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Country | US
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Telephone | 870-935-9100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBRA LYNN CALLAHAN
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Credential | DC
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Telephone | 870-935-9100
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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 | 1415
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License Number State | AR
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