Provider Demographics
NPI:1063470334
Name:HINES, JOSEPH G (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:HINES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3294
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59002OtherCHIROPRACTOR
AR59002OtherCHIROPRACTOR
ART20510Medicare UPIN