Provider Demographics
NPI:1124034947
Name:FOREST PARK MEDICAL AND CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:FOREST PARK MEDICAL AND CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:HARROL
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-661-1303
Mailing Address - Street 1:1119 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1847
Mailing Address - Country:US
Mailing Address - Phone:501-661-1303
Mailing Address - Fax:501-661-1323
Practice Address - Street 1:1119 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1847
Practice Address - Country:US
Practice Address - Phone:501-661-1303
Practice Address - Fax:501-661-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3397261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR34900Medicare UPIN