Provider Demographics
NPI:1366213399
Name:AVISE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:AVISE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-601-1194
Mailing Address - Street 1:95 SOUTHWINDS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2954
Mailing Address - Country:US
Mailing Address - Phone:479-601-1194
Mailing Address - Fax:479-406-4343
Practice Address - Street 1:95 SOUTHWINDS RD STE 2
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2954
Practice Address - Country:US
Practice Address - Phone:479-601-1194
Practice Address - Fax:479-406-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty