Provider Demographics
NPI:1922207828
Name:ESTES CHIROPRACTIC
Entity Type:Organization
Organization Name:ESTES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:479-271-2273
Mailing Address - Street 1:113 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5232
Mailing Address - Country:US
Mailing Address - Phone:479-271-2273
Mailing Address - Fax:479-271-2109
Practice Address - Street 1:113 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5232
Practice Address - Country:US
Practice Address - Phone:479-271-2273
Practice Address - Fax:479-271-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#1256305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F658OtherBCBS CLINIC
AR5U573OtherBCBS
AR59784OtherBLUE CROSS
AR5F658OtherBCBS CLINIC