Provider Demographics
NPI:1831480805
Name:UNGERANK CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:UNGERANK CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:UNGERANK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-238-8210
Mailing Address - Street 1:711 ELDRIDGE AVE E STE A
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-238-8210
Mailing Address - Fax:870-238-8210
Practice Address - Street 1:711 ELDRIDGE AVE E STE A
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4032
Practice Address - Country:US
Practice Address - Phone:870-238-8210
Practice Address - Fax:870-238-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115848718Medicaid
AR115848718Medicaid