Provider Demographics
NPI:1821040726
Name:JOE HINES CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:JOE HINES CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:479-636-4021
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-0609
Mailing Address - Country:US
Mailing Address - Phone:479-636-4021
Mailing Address - Fax:479-636-4023
Practice Address - Street 1:205 N 24TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3294
Practice Address - Country:US
Practice Address - Phone:479-636-4021
Practice Address - Fax:479-636-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59002OtherCHIROPRACTOR
ART20510Medicare UPIN
AR59002OtherCHIROPRACTOR