Provider Demographics
NPI:1699856872
Name:GEORGE CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:GEORGE CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-238-8707
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:1718 N FALLS BLVD
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0498
Mailing Address - Country:US
Mailing Address - Phone:870-238-8707
Mailing Address - Fax:870-238-8711
Practice Address - Street 1:1718 N FALLS BLVD
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-0498
Practice Address - Country:US
Practice Address - Phone:870-238-8707
Practice Address - Fax:870-238-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1452261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T670OtherBLUE CROSS AND BLUE SHIEL
AR5T670Medicare ID - Type Unspecified
ARU67852Medicare UPIN