Provider Demographics
NPI:1326883828
Name:STIDHAM CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:STIDHAM CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-236-8006
Mailing Address - Street 1:1715 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5820
Mailing Address - Country:US
Mailing Address - Phone:870-236-8006
Mailing Address - Fax:870-236-3942
Practice Address - Street 1:1715 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5820
Practice Address - Country:US
Practice Address - Phone:870-236-8006
Practice Address - Fax:870-236-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty