Provider Demographics
NPI:1013130236
Name:SEWELL HEALTHWISE CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:SEWELL HEALTHWISE CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-756-9661
Mailing Address - Street 1:3291 S THOMPSON ST
Mailing Address - Street 2:STE D102
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7043
Mailing Address - Country:US
Mailing Address - Phone:479-756-9661
Mailing Address - Fax:479-756-6251
Practice Address - Street 1:3291 S THOMPSON ST
Practice Address - Street 2:STE D102
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7043
Practice Address - Country:US
Practice Address - Phone:479-756-9661
Practice Address - Fax:479-756-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU74593Medicare UPIN
AR5U311Medicare ID - Type Unspecified