Provider Demographics
NPI:1992811285
Name:NESTERENKO, PAUL ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:NESTERENKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SHACKLEFORD RD STE B3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2882
Mailing Address - Country:US
Mailing Address - Phone:501-223-5130
Mailing Address - Fax:501-223-8043
Practice Address - Street 1:301 N SHACKLEFORD RD STE B3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2882
Practice Address - Country:US
Practice Address - Phone:501-223-5130
Practice Address - Fax:501-223-8043
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S657Medicare ID - Type Unspecified