1699856872 NPI number — GEORGE CHIROPRACTIC CLINIC INC.

Table of content: JESSICA ROSE COCHRAN RN (NPI 1396465589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699856872 NPI number — GEORGE CHIROPRACTIC CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE CHIROPRACTIC CLINIC INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699856872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 498
Provider Second Line Business Mailing Address:
1718 N FALLS BLVD
Provider Business Mailing Address City Name:
WYNNE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72396-0498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-238-8707
Provider Business Mailing Address Fax Number:
870-238-8711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 N FALLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNNE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72396-0498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-238-8707
Provider Business Practice Location Address Fax Number:
870-238-8711
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
DEWAYNE
Authorized Official Title or Position:
DOCTOR OWNER
Authorized Official Telephone Number:
870-238-8707

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  1452 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5T670 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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