Provider Demographics
NPI:1851429021
Name:HILL, JACKIE RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:RAY
Last Name:HILL
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:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-1254
Mailing Address - Country:US
Mailing Address - Phone:501-843-9516
Mailing Address - Fax:501-843-9516
Practice Address - Street 1:1902 S PINE ST STE A
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8180
Practice Address - Country:US
Practice Address - Phone:501-843-9516
Practice Address - Fax:501-843-9516
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor