Provider Demographics
NPI:1750505392
Name:MULANAX, NATHAN DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DALE
Last Name:MULANAX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CRANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3629
Mailing Address - Country:US
Mailing Address - Phone:870-704-4072
Mailing Address - Fax:870-743-9881
Practice Address - Street 1:105 E CRANDALL AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3629
Practice Address - Country:US
Practice Address - Phone:870-704-4072
Practice Address - Fax:870-743-9881
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167484718Medicaid
AR5A367OtherBCBS
AR167484718Medicaid