Provider Demographics
NPI:1073775615
Name:JIM SCHILLING CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:JIM SCHILLING CHIROPRACTIC P.A.
Other - Org Name:ELITE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-420-6602
Mailing Address - Street 1:1200 S WALDRON RD
Mailing Address - Street 2:STE155
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2629
Mailing Address - Country:US
Mailing Address - Phone:479-452-4433
Mailing Address - Fax:479-452-0034
Practice Address - Street 1:1200 S WALDRON RD
Practice Address - Street 2:STE155
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2629
Practice Address - Country:US
Practice Address - Phone:479-452-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1578738423Medicare UPIN