Provider Demographics
NPI:1518160076
Name:MUNSON CHIROPRACTIC
Entity Type:Organization
Organization Name:MUNSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-254-1177
Mailing Address - Street 1:3105 NE 11TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9102
Mailing Address - Country:US
Mailing Address - Phone:479-254-1177
Mailing Address - Fax:479-254-1193
Practice Address - Street 1:3105 NE 11TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9102
Practice Address - Country:US
Practice Address - Phone:479-254-1177
Practice Address - Fax:479-254-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F767OtherBLUECROSS BLUESHIELD ID