Provider Demographics
NPI:1326182585
Name:BASCO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BASCO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-248-3300
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-0803
Mailing Address - Country:US
Mailing Address - Phone:870-248-3300
Mailing Address - Fax:870-248-3300
Practice Address - Street 1:302 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9131
Practice Address - Country:US
Practice Address - Phone:870-248-3300
Practice Address - Fax:870-248-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty