1801237169 NPI number — ADJUST FOR VITALITY CHIROPRACTIC & ACUPUNCTURE

Table of content: (NPI 1801237169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801237169 NPI number — ADJUST FOR VITALITY CHIROPRACTIC & ACUPUNCTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADJUST FOR VITALITY CHIROPRACTIC & ACUPUNCTURE
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:
1801237169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 NE MOBERLY LN
Provider Second Line Business Mailing Address:
APT R10
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712-6144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-670-1438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 FOREST HILLS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLA VISTA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72715-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-657-2112
Provider Business Practice Location Address Fax Number:
479-657-2117
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
SHAUN
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
479-670-1438

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  2012028482 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com