Provider Demographics
NPI:1336297027
Name:JERRY F. HINES D.C. INC
Entity Type:Organization
Organization Name:JERRY F. HINES D.C. INC
Other - Org Name:HINES HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-636-3021
Mailing Address - Street 1:305 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3294
Mailing Address - Country:US
Mailing Address - Phone:479-363-3021
Mailing Address - Fax:479-636-9171
Practice Address - Street 1:305 N 24TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3294
Practice Address - Country:US
Practice Address - Phone:479-363-3021
Practice Address - Fax:479-636-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56786Medicare PIN