Provider Demographics
NPI:1447557079
Name:HUNTINGTON CLINIC PA
Entity Type:Organization
Organization Name:HUNTINGTON CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:479-751-8154
Mailing Address - Street 1:700 WEST SUNSET
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764
Mailing Address - Country:US
Mailing Address - Phone:479-751-8154
Mailing Address - Fax:479-751-5362
Practice Address - Street 1:700 WEST SUNSET
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-751-8154
Practice Address - Fax:479-751-5362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTINGTON CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
59430Medicare PIN
T20652Medicare UPIN