Provider Demographics
NPI:1366421547
Name:SPINAL TRAUMA RECOVERY INC
Entity type:Organization
Organization Name:SPINAL TRAUMA RECOVERY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MATTHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-783-0369
Mailing Address - Street 1:PO BOX 23601
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-0601
Mailing Address - Country:US
Mailing Address - Phone:479-783-0369
Mailing Address - Fax:479-783-0419
Practice Address - Street 1:720A STROZIER LN
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-1735
Practice Address - Country:US
Practice Address - Phone:479-783-0369
Practice Address - Fax:479-783-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C831OtherPTAN