Provider Demographics
NPI:1417214230
Name:IMPACT HEALTH
Entity Type:Organization
Organization Name:IMPACT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:479-254-3999
Mailing Address - Street 1:1401 SE WALTON BLVD
Mailing Address - Street 2:113
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3759
Mailing Address - Country:US
Mailing Address - Phone:479-254-3999
Mailing Address - Fax:479-254-3998
Practice Address - Street 1:1401 SE WALTON BLVD
Practice Address - Street 2:113
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3759
Practice Address - Country:US
Practice Address - Phone:479-254-3999
Practice Address - Fax:479-254-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR154720111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty