Provider Demographics
NPI:1952754251
Name:FAVORITE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:FAVORITE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:FAVORITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-756-1155
Mailing Address - Street 1:1127 S GUTENSOHN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5228
Mailing Address - Country:US
Mailing Address - Phone:479-756-1155
Mailing Address - Fax:479-756-1130
Practice Address - Street 1:1127 S GUTENSOHN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5228
Practice Address - Country:US
Practice Address - Phone:479-756-1155
Practice Address - Fax:479-756-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A018OtherPTAN