Provider Demographics
NPI: | 1104285857 |
---|---|
Name: | PINNACLE CHIROPRACTIC |
Entity type: | Organization |
Organization Name: | PINNACLE CHIROPRACTIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JONATHAN |
Authorized Official - Middle Name: | DAVID |
Authorized Official - Last Name: | JAMESON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 501-673-3110 |
Mailing Address - Street 1: | 5507 RANCH DR |
Mailing Address - Street 2: | STE 3 |
Mailing Address - City: | LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72223-4538 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-673-3110 |
Mailing Address - Fax: | 501-673-3159 |
Practice Address - Street 1: | 5507 RANCH DR |
Practice Address - Street 2: | STE 3 |
Practice Address - City: | LITTLE ROCK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72223-4538 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-673-3110 |
Practice Address - Fax: | 501-673-3159 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-22 |
Last Update Date: | 2016-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | 15751 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |