Provider Demographics
NPI:1356413371
Name:OZARK CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:OZARK CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:ULMSCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-667-5053
Mailing Address - Street 1:600 W COLLEGE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949
Mailing Address - Country:US
Mailing Address - Phone:479-667-5053
Mailing Address - Fax:479-667-5341
Practice Address - Street 1:600 W COLLEGE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949
Practice Address - Country:US
Practice Address - Phone:479-667-5053
Practice Address - Fax:479-667-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57917Medicare ID - Type Unspecified
T0732Medicare UPIN