Provider Demographics
NPI:1922551563
Name:NATURAL STATE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:NATURAL STATE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:QUAYED
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-319-6211
Mailing Address - Street 1:1803 SW REGIONAL AIRPORT BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8792
Mailing Address - Country:US
Mailing Address - Phone:479-319-6211
Mailing Address - Fax:
Practice Address - Street 1:1803 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:STE. 9
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7755
Practice Address - Country:US
Practice Address - Phone:479-319-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty