Provider Demographics
NPI:1760837652
Name:ARBOR VITAE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ARBOR VITAE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-208-6766
Mailing Address - Street 1:1401 S WALTON BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6139
Mailing Address - Country:US
Mailing Address - Phone:479-208-6766
Mailing Address - Fax:479-435-7120
Practice Address - Street 1:1401 S WALTON BLVD STE 25
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6139
Practice Address - Country:US
Practice Address - Phone:479-208-6766
Practice Address - Fax:479-435-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty