Provider Demographics
NPI:1861902496
Name:ABIDE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ABIDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-435-6888
Mailing Address - Street 1:3761 N MALL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4972
Mailing Address - Country:US
Mailing Address - Phone:479-435-6888
Mailing Address - Fax:479-435-6077
Practice Address - Street 1:3761 N MALL AVE STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4972
Practice Address - Country:US
Practice Address - Phone:479-435-6888
Practice Address - Fax:479-435-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty