MEDICARE: DR. JACLYN NICOLE CROWDER DC

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	171100000X	Acupuncturist	16381	AR
2	111N00000X	Chiropractor	16381	AR

General Provider Information

NPI Number	:	1982318606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN NICOLE CROWDER DC

Provider Business Mailing Address
First Line	:	2618 W MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7698
Country	:	US
Telephone Number	:	479-521-7755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 W MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7698
Country	:	US
Telephone Number	:	479-521-7755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	03/26/2024

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