Provider Demographics
NPI:1639741986
Name:SOUTHSIDE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SOUTHSIDE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-613-1464
Mailing Address - Street 1:1997 BATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7896
Mailing Address - Country:US
Mailing Address - Phone:870-613-1464
Mailing Address - Fax:
Practice Address - Street 1:1997 BATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AR
Practice Address - Zip Code:72501-7896
Practice Address - Country:US
Practice Address - Phone:870-613-1464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center