Provider Demographics
NPI:1144474438
Name:LIGHT'S CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:LIGHT'S CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATAUSHA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-933-9600
Mailing Address - Street 1:802 HESTER ST APT B3
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3785
Mailing Address - Country:US
Mailing Address - Phone:870-933-9600
Mailing Address - Fax:
Practice Address - Street 1:325 SOUTHWEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5854
Practice Address - Country:US
Practice Address - Phone:870-933-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty