Provider Demographics
NPI:1396384962
Name:CORE CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-246-4485
Mailing Address - Street 1:11525 CANTRELL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-1713
Mailing Address - Country:US
Mailing Address - Phone:501-246-4485
Mailing Address - Fax:
Practice Address - Street 1:11525 CANTRELL RD STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-1713
Practice Address - Country:US
Practice Address - Phone:501-246-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty