Provider Demographics
NPI:1104979665
Name:MYSHKA CLINIC, PA
Entity type:Organization
Organization Name:MYSHKA CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:MYSHKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-932-5661
Mailing Address - Street 1:2817 S CARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7305
Mailing Address - Country:US
Mailing Address - Phone:870-932-5661
Mailing Address - Fax:870-932-0890
Practice Address - Street 1:2817 S CARAWAY RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7305
Practice Address - Country:US
Practice Address - Phone:870-932-5661
Practice Address - Fax:870-932-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59592OtherAR BCBS NUMBER
AR59592OtherAR BCBS NUMBER
AR57545Medicare PIN