Provider Demographics
NPI:1346471661
Name:DECLERK, REX PAUL BRADY (DC)
Entity Type:Individual
Prefix:DR
First Name:REX PAUL
Middle Name:BRADY
Last Name:DECLERK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 COLONEL GLENN RD STE 6200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2370
Mailing Address - Country:US
Mailing Address - Phone:501-313-2844
Mailing Address - Fax:501-325-3754
Practice Address - Street 1:12120 COLONEL GLENN RD STE 6200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2370
Practice Address - Country:US
Practice Address - Phone:501-313-2844
Practice Address - Fax:501-325-3754
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor