Provider Demographics
NPI:1700152303
Name:JJ GLIEDT PLLC
Entity Type:Organization
Organization Name:JJ GLIEDT PLLC
Other - Org Name:NWA SPINE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-586-5474
Mailing Address - Street 1:3900 N PARKVIEW DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6398
Mailing Address - Country:US
Mailing Address - Phone:479-586-5474
Mailing Address - Fax:
Practice Address - Street 1:3900 N PARKVIEW DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6398
Practice Address - Country:US
Practice Address - Phone:479-586-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty