Provider Demographics
NPI:1306116777
Name:ACCIDENT & INJURY CENTER OF SOUTH ARKANSAS
Entity type:Organization
Organization Name:ACCIDENT & INJURY CENTER OF SOUTH ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-862-2121
Mailing Address - Street 1:431 E HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-7303
Mailing Address - Country:US
Mailing Address - Phone:870-862-2121
Mailing Address - Fax:870-862-2116
Practice Address - Street 1:431 E HILLSBORO ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-7303
Practice Address - Country:US
Practice Address - Phone:870-862-2121
Practice Address - Fax:870-862-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty