Provider Demographics
NPI:1215033543
Name:AVISE, DARREN JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:JAMES
Last Name:AVISE
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 1:95 SOUTHWINDS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2954
Mailing Address - Country:US
Mailing Address - Phone:479-601-1194
Mailing Address - Fax:479-406-4343
Practice Address - Street 1:95 SOUTHWINDS RD STE 2
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2954
Practice Address - Country:US
Practice Address - Phone:479-601-1194
Practice Address - Fax:479-406-4343
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5398AVOtherREGENCE BLUE SHIELD
WA139636OtherDEPT OF LABOR & INDUST
WA8927553OtherDEPT OF CRIME VICTIMS
WA139636OtherDEPT OF LABOR & INDUST
WA5398AVOtherREGENCE BLUE SHIELD