Provider Demographics
NPI:1043805708
Name:JRJ FAMILY ENTERPRISES LLC
Entity Type:Organization
Organization Name:JRJ FAMILY ENTERPRISES LLC
Other - Org Name:OZARK VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-454-9961
Mailing Address - Street 1:1401 SW 14TH ST STE 99
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3634
Mailing Address - Country:US
Mailing Address - Phone:501-454-9961
Mailing Address - Fax:
Practice Address - Street 1:1401 SW 14TH ST STE 9
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3679
Practice Address - Country:US
Practice Address - Phone:479-595-8726
Practice Address - Fax:479-282-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty