Provider Demographics
NPI:1073831723
Name:P. S. E. CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:P. S. E. CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ENGELHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-753-6034
Mailing Address - Street 1:4401 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-3621
Mailing Address - Country:US
Mailing Address - Phone:501-753-6034
Mailing Address - Fax:501-753-1487
Practice Address - Street 1:4401 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-3621
Practice Address - Country:US
Practice Address - Phone:501-753-6034
Practice Address - Fax:501-753-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20596Medicare UPIN