Provider Demographics
NPI:1891839742
Name:JOSEPH DIK CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:JOSEPH DIK CHIROPRACTIC P.A.
Other - Org Name:BENTONVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-273-5855
Mailing Address - Street 1:3400 SE MACY RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-273-5855
Mailing Address - Fax:
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:SUITE 30
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-273-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y637OtherBLUECROSSBLUESHEILD
AR5Y637Medicare ID - Type Unspecified