Provider Demographics
NPI:1124025234
Name:MCGEHEE, JIMMY SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:SHAWN
Last Name:MCGEHEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 HARKRIDER ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5631
Mailing Address - Country:US
Mailing Address - Phone:501-327-4484
Mailing Address - Fax:501-327-5963
Practice Address - Street 1:523 HARKRIDER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5631
Practice Address - Country:US
Practice Address - Phone:501-327-4484
Practice Address - Fax:501-327-5963
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66266Medicare UPIN
AR5T578Medicare ID - Type Unspecified