Provider Demographics
NPI:1124276225
Name:COATS CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:COATS CHIROPRACTIC CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-446-6426
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AR
Mailing Address - Zip Code:72641-0181
Mailing Address - Country:US
Mailing Address - Phone:870-446-6426
Mailing Address - Fax:
Practice Address - Street 1:514 WEST CLARK
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641-0181
Practice Address - Country:US
Practice Address - Phone:870-446-6426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COATS CHIROPRACTIC CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1501261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138994718Medicaid
AR5U343Medicare PIN