Provider Demographics
NPI:1457621690
Name:CENTRAL ARKANSAS CHIROPRACTIC NORTH LITTLE ROCK,PLLC
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS CHIROPRACTIC NORTH LITTLE ROCK,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REX PAUL
Authorized Official - Middle Name:BRADY
Authorized Official - Last Name:DECLERK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-850-8400
Mailing Address - Street 1:4196 E MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2523
Mailing Address - Country:US
Mailing Address - Phone:501-850-8400
Mailing Address - Fax:501-850-8401
Practice Address - Street 1:4196 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2523
Practice Address - Country:US
Practice Address - Phone:501-850-8400
Practice Address - Fax:501-850-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty