Provider Demographics
NPI:1306102181
Name:MICHAEL C OLDHAM D C P A
Entity type:Organization
Organization Name:MICHAEL C OLDHAM D C P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:870-763-8155
Mailing Address - Street 1:827 E MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2521
Mailing Address - Country:US
Mailing Address - Phone:870-763-8155
Mailing Address - Fax:870-838-1589
Practice Address - Street 1:827 E MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2521
Practice Address - Country:US
Practice Address - Phone:870-763-8155
Practice Address - Fax:870-838-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty