Provider Demographics
NPI:1689893760
Name:CHANDLER CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:CHANDLER CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-524-5555
Mailing Address - Street 1:2023 E. MAIN ST.
Mailing Address - Street 2:STE. C
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5504
Mailing Address - Country:US
Mailing Address - Phone:479-524-5555
Mailing Address - Fax:479-524-8054
Practice Address - Street 1:2023 E. MAIN ST.
Practice Address - Street 2:STE. C
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-5504
Practice Address - Country:US
Practice Address - Phone:479-524-5555
Practice Address - Fax:479-524-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1384111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T106OtherBCBS
U57719Medicare UPIN
AR5T106Medicare ID - Type Unspecified