Provider Demographics
NPI:1114123940
Name:HEALTH CHOICE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HEALTH CHOICE CHIROPRACTIC INC
Other - Org Name:HEALTH CHOICE CHIROPRACTIC AND MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-358-4894
Mailing Address - Street 1:611 COURT ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5446
Mailing Address - Country:US
Mailing Address - Phone:501-358-4894
Mailing Address - Fax:501-358-4891
Practice Address - Street 1:611 COURT ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5446
Practice Address - Country:US
Practice Address - Phone:501-358-4894
Practice Address - Fax:501-358-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142756718Medicaid
WY21462OtherMEDICARE PTAN
AR5W289Medicare ID - Type UnspecifiedCLINIC PROVIDER
ARU83930Medicare UPIN