Provider Demographics
NPI:1366636169
Name:VINCENT, JOHN PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:VINCENT
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 1:13401 CHENAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5383
Mailing Address - Country:US
Mailing Address - Phone:501-821-6934
Mailing Address - Fax:501-224-1277
Practice Address - Street 1:17200 CHENAL PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5944
Practice Address - Country:US
Practice Address - Phone:501-821-6934
Practice Address - Fax:501-821-6915
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07780111N00000X
AR1791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor