Provider Demographics
NPI:1104431170
Name:POWER CHIROPRACTIC, PA
Entity type:Organization
Organization Name:POWER 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:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-307-4798
Mailing Address - Street 1:1070 S SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7223
Mailing Address - Country:US
Mailing Address - Phone:870-307-4798
Mailing Address - Fax:870-569-8128
Practice Address - Street 1:2600 E PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2266
Practice Address - Country:US
Practice Address - Phone:479-219-5030
Practice Address - Fax:479-219-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty