Provider Demographics
NPI:1922243807
Name:THE PINE BLUFF GROUP, PLLC
Entity Type:Organization
Organization Name:THE PINE BLUFF GROUP, PLLC
Other - Org Name:LIBERTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-708-8886
Mailing Address - Street 1:2102 S. OLIVE ST.
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601
Mailing Address - Country:US
Mailing Address - Phone:870-540-1200
Mailing Address - Fax:870-540-1208
Practice Address - Street 1:2102 S. OLIVE ST.
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601
Practice Address - Country:US
Practice Address - Phone:870-540-1200
Practice Address - Fax:870-540-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty