MEDICARE: DODSON AVENUE CHIROPRACTIC CLINIC,LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1028	AR

General Provider Information

NPI Number	:	1376558890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DODSON AVENUE CHIROPRACTIC CLINIC,LTD

Provider Business Mailing Address
First Line	:	2001 DODSON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4823
Country	:	US
Telephone Number	:	479-782-3778
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 DODSON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4823
Country	:	US
Telephone Number	:	479-782-3778
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD CHARLES WARD
Credential	:	D.C.
Telephone Number	:	479-782-3778

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/22/2020

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