Provider Demographics
NPI:1164711495
Name:SOUTHWEST CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SOUTHWEST CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KIRCHHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-845-0707
Mailing Address - Street 1:208 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-2408
Mailing Address - Country:US
Mailing Address - Phone:870-845-0707
Mailing Address - Fax:870-845-0101
Practice Address - Street 1:208 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-2408
Practice Address - Country:US
Practice Address - Phone:870-845-0707
Practice Address - Fax:870-845-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y204OtherMEDICARE