1417962721 NPI number — DR. MATTHEW C. HUNEYCUTT D.C.

Table of content: DR. MATTHEW C. HUNEYCUTT D.C. (NPI 1417962721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417962721 NPI number — DR. MATTHEW C. HUNEYCUTT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNEYCUTT
Provider First Name:
MATTHEW
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNEYCUTT
Provider Other First Name:
MATT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417962721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25255 HIGHWAY 5
Provider Second Line Business Mailing Address:
STE K
Provider Business Mailing Address City Name:
LONSDALE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72087-9102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-568-6612
Provider Business Mailing Address Fax Number:
501-568-7454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7117 GEYER SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72209-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-568-6612
Provider Business Practice Location Address Fax Number:
501-568-7454
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1621 , 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: 5X997 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7470597 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00144384 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2222627 . This is a "FIRST HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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