MEDICARE: EGGLESTON CHIROPRACTIC & REHAB, INC.

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	1418	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568697290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGGLESTON CHIROPRACTIC & REHAB, INC.

Provider Business Mailing Address
First Line	:	3000 N MARKET AVE STE C
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-575-0105
Fax Number	:	479-575-0205

Provider Business Practice Location Address
First Line	:	3000 N MARKET AVE STE C
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-575-0105
Fax Number	:	479-575-0205

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL LEE EGGLESTON
Credential	:	DC
Telephone Number	:	479-575-0105

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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