Provider Demographics
NPI:1275758732
Name:DRYER CHIROPRACTIC PA
Entity Type:Organization
Organization Name:DRYER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-935-0102
Mailing Address - Street 1:2912 BROWNS LN SUITE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7237
Mailing Address - Country:US
Mailing Address - Phone:870-935-0102
Mailing Address - Fax:870-935-7622
Practice Address - Street 1:2912 BROWNS LN SUITE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7237
Practice Address - Country:US
Practice Address - Phone:870-935-0102
Practice Address - Fax:870-935-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR18022718Medicaid
AR18022718Medicaid