Provider Demographics
NPI:1356356018
Name:CO-LU INC
Entity type:Organization
Organization Name:CO-LU INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORNELISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-221-4357
Mailing Address - Street 1:PO BOX 242161
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0021
Mailing Address - Country:US
Mailing Address - Phone:501-221-4357
Mailing Address - Fax:501-221-4379
Practice Address - Street 1:11523 KANIS RD
Practice Address - Street 2:SUITE D
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3724
Practice Address - Country:US
Practice Address - Phone:501-221-4357
Practice Address - Fax:501-221-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C949Medicare PIN