Provider Demographics
NPI:1790440972
Name:OMNIS REHAB NORTH LITTLE ROCK LLC
Entity Type:Organization
Organization Name:OMNIS REHAB NORTH LITTLE ROCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX PAUL
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:DECLERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-454-4528
Mailing Address - Street 1:12120 COLONEL GLENN RD STE 6200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2370
Mailing Address - Country:US
Mailing Address - Phone:501-313-2844
Mailing Address - Fax:
Practice Address - Street 1:5107 WARDEN RD STE 7
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7089
Practice Address - Country:US
Practice Address - Phone:501-353-1781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNIS REHAB L.L.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty