Provider Demographics
NPI:1942369798
Name:CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-4663
Mailing Address - Street 1:300 S RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4747
Mailing Address - Country:US
Mailing Address - Phone:501-663-4663
Mailing Address - Fax:501-663-7689
Practice Address - Street 1:300 S RODNEY PARHAM RD
Practice Address - Street 2:SUITE 11
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4774
Practice Address - Country:US
Practice Address - Phone:501-663-4663
Practice Address - Fax:501-663-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1435 & 1085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G015OtherBLUE CROSS GROUP
AR5G015OtherMEDICARE GROUP
ARDN3101OtherRR MEDICARE-PALMETTO
AR19689000000OtherQUAL CHOICE GROUP
AR167431718Medicaid