Provider Demographics
NPI:1487654901
Name:JARNAGIN, KYLE D (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:JARNAGIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 OLD GREENWOOD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5462
Mailing Address - Country:US
Mailing Address - Phone:497-646-3984
Mailing Address - Fax:479-646-2129
Practice Address - Street 1:3444 OLD GREENWOOD RD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5462
Practice Address - Country:US
Practice Address - Phone:497-646-3984
Practice Address - Fax:479-646-2129
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175859718Medicaid
AR5X860Medicare ID - Type Unspecified