Provider Demographics
NPI:1538433263
Name:STEPHENS CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:STEPHENS CHIROPRACTIC CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-535-6101
Mailing Address - Street 1:2007 WEST 28TH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603
Mailing Address - Country:US
Mailing Address - Phone:870-535-6101
Mailing Address - Fax:870-535-3005
Practice Address - Street 1:2007 WEST 28TH
Practice Address - Street 2:SUITE 1
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-535-6101
Practice Address - Fax:870-535-3005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS CHIROPRACTIC CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#1081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty