Provider Demographics
NPI:1962563924
Name:THE GARRETSON CLINIC, P.A.
Entity type:Organization
Organization Name:THE GARRETSON CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:GARRETSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-425-4222
Mailing Address - Street 1:306 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3945
Mailing Address - Country:US
Mailing Address - Phone:870-425-4222
Mailing Address - Fax:870-425-4223
Practice Address - Street 1:306 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3945
Practice Address - Country:US
Practice Address - Phone:870-425-4222
Practice Address - Fax:870-425-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B739Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER