Provider Demographics
NPI:1114274297
Name:STICE CHIROPRACTIC & WELLNESS, PLLC
Entity Type:Organization
Organization Name:STICE CHIROPRACTIC & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:STICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-449-2200
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:AR
Mailing Address - Zip Code:72677-0151
Mailing Address - Country:US
Mailing Address - Phone:870-449-2200
Mailing Address - Fax:870-449-5570
Practice Address - Street 1:127 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:AR
Practice Address - Zip Code:72677-0151
Practice Address - Country:US
Practice Address - Phone:870-449-2200
Practice Address - Fax:870-449-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15996261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center