Provider Demographics
NPI:1669658647
Name:DR. JIM WEATHERLEY, D.C., P.A.
Entity Type:Organization
Organization Name:DR. JIM WEATHERLEY, D.C., P.A.
Other - Org Name:NATURAL STATE CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-327-3355
Mailing Address - Street 1:2665 DONAGHEY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2317
Mailing Address - Country:US
Mailing Address - Phone:501-327-3355
Mailing Address - Fax:501-327-3360
Practice Address - Street 1:2665 DONAGHEY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2317
Practice Address - Country:US
Practice Address - Phone:501-327-3355
Practice Address - Fax:501-327-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A433Medicare PIN