Provider Demographics
NPI:1699823971
Name:TAYLOR-PICKETT CHIROPRACTIC
Entity Type:Organization
Organization Name:TAYLOR-PICKETT CHIROPRACTIC
Other - Org Name:PICKETT FAMILY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANA
Authorized Official - Middle Name:DION
Authorized Official - Last Name:TAYLOR-PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-892-3337
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-0582
Mailing Address - Country:US
Mailing Address - Phone:870-892-3337
Mailing Address - Fax:870-892-3337
Practice Address - Street 1:2694 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1202
Practice Address - Country:US
Practice Address - Phone:870-892-3337
Practice Address - Fax:870-892-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1333111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU43021Medicare UPIN
AR5B381Medicare ID - Type Unspecified