Provider Demographics
NPI:1326082629
Name:COURTNEY CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:COURTNEY CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-1231
Mailing Address - Street 1:1421 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5621
Mailing Address - Country:US
Mailing Address - Phone:870-534-1231
Mailing Address - Fax:870-534-3945
Practice Address - Street 1:1421 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5621
Practice Address - Country:US
Practice Address - Phone:870-534-1231
Practice Address - Fax:870-534-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20573Medicare UPIN