Provider Demographics
NPI:1497763791
Name:BALKMAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BALKMAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JARNAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-646-3984
Mailing Address - Street 1:3444 OLD GREENWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5462
Mailing Address - Country:US
Mailing Address - Phone:479-646-3984
Mailing Address - Fax:479-646-2129
Practice Address - Street 1:3444 OLD GREENWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5462
Practice Address - Country:US
Practice Address - Phone:479-646-3984
Practice Address - Fax:479-646-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11464121OtherCAQH
AR11464121OtherCAQH