Provider Demographics
NPI:1780381053
Name:PCM CHIROPRACTIC, PA
Entity type:Organization
Organization Name:PCM CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-307-4798
Mailing Address - Street 1:201 COMMERCE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6708
Mailing Address - Country:US
Mailing Address - Phone:501-333-9330
Mailing Address - Fax:501-333-9335
Practice Address - Street 1:201 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6708
Practice Address - Country:US
Practice Address - Phone:501-333-9330
Practice Address - Fax:501-333-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty