Provider Demographics
NPI:1700283504
Name:MATT HUNEYCUTT, D.C. PLLC
Entity Type:Organization
Organization Name:MATT HUNEYCUTT, D.C. PLLC
Other - Org Name:BACK 2 HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-922-5621
Mailing Address - Street 1:25255 HIGHWAY 5
Mailing Address - Street 2:SUITE K
Mailing Address - City:LONSDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72087-9519
Mailing Address - Country:US
Mailing Address - Phone:501-922-5621
Mailing Address - Fax:
Practice Address - Street 1:25255 HIGHWAY 5
Practice Address - Street 2:SUITE K
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087-9519
Practice Address - Country:US
Practice Address - Phone:501-922-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR378930Medicare UPIN