Provider Demographics
NPI:1407931744
Name:GARRETSON, DEANNA LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LYN
Last Name:GARRETSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3945
Mailing Address - Country:US
Mailing Address - Phone:870-425-4222
Mailing Address - Fax:870-425-4223
Practice Address - Street 1:306 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3945
Practice Address - Country:US
Practice Address - Phone:870-425-4222
Practice Address - Fax:870-425-4223
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59243B739OtherBLUE CROSS/BLUE SHIELD
ART20615Medicare UPIN
AR59243B739Medicare ID - Type Unspecified