Provider Demographics
NPI:1033821467
Name:BACK 40 CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:BACK 40 CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-888-8122
Mailing Address - Street 1:51 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3242
Mailing Address - Country:US
Mailing Address - Phone:808-779-0144
Mailing Address - Fax:
Practice Address - Street 1:3406 BELLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-5700
Practice Address - Country:US
Practice Address - Phone:479-888-8122
Practice Address - Fax:479-487-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty