Provider Demographics
NPI:1235158296
Name:CHENAL CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:CHENAL CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-821-6934
Mailing Address - Street 1:17200 CHENAL PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5944
Mailing Address - Country:US
Mailing Address - Phone:501-821-6934
Mailing Address - Fax:501-821-6915
Practice Address - Street 1:17200 CHENAL PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5944
Practice Address - Country:US
Practice Address - Phone:501-821-6934
Practice Address - Fax:501-821-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F518Medicare ID - Type Unspecified