Provider Demographics
NPI:1477889566
Name:SANTOS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:SANTOS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-464-4413
Mailing Address - Street 1:1706 SE WALTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3200
Mailing Address - Country:US
Mailing Address - Phone:479-464-4413
Mailing Address - Fax:479-464-4430
Practice Address - Street 1:1706 SE WALTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3200
Practice Address - Country:US
Practice Address - Phone:479-464-4413
Practice Address - Fax:479-464-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty