Provider Demographics
NPI:1578571220
Name:T.K. HUTSON ENTERPRISES, LLC
Entity Type:Organization
Organization Name:T.K. HUTSON ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-356-2019
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-0825
Mailing Address - Country:US
Mailing Address - Phone:870-356-2019
Mailing Address - Fax:870-356-2070
Practice Address - Street 1:400 EAST BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943
Practice Address - Country:US
Practice Address - Phone:870-356-2019
Practice Address - Fax:870-356-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152289718Medicaid
AR5T785Medicare ID - Type Unspecified
AR152289718Medicaid