Provider Demographics
NPI:1063677268
Name:NESTERENKO SPECIFIC CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:NESTERENKO SPECIFIC CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NESTERENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-223-5130
Mailing Address - Street 1:13601 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3146
Mailing Address - Country:US
Mailing Address - Phone:501-223-5130
Mailing Address - Fax:
Practice Address - Street 1:13601 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3146
Practice Address - Country:US
Practice Address - Phone:501-223-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S657OtherBLUE CROSS BLUE SHIELD
ARU46723OtherBLUE CROSS BLUE SHIELD