Provider Demographics
NPI:1326269887
Name:WARD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:WARD CHIROPRACTIC CLINIC
Other - Org Name:DR KRISTY GRAHAM CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-474-1722
Mailing Address - Street 1:801 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5833
Mailing Address - Country:US
Mailing Address - Phone:479-474-1722
Mailing Address - Fax:479-474-1743
Practice Address - Street 1:801 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5833
Practice Address - Country:US
Practice Address - Phone:479-474-1722
Practice Address - Fax:479-474-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU60336Medicare UPIN
5B803Medicare PIN
AR5B803Medicare ID - Type Unspecified