Provider Demographics
NPI:1043777436
Name:AMETHYST CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:AMETHYST CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-484-2562
Mailing Address - Street 1:2303 SW PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7578
Mailing Address - Country:US
Mailing Address - Phone:404-484-2562
Mailing Address - Fax:
Practice Address - Street 1:1100 MALLARD PL STE A
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6850
Practice Address - Country:US
Practice Address - Phone:404-484-2562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center