Provider Demographics
NPI:1053596700
Name:NWA CHIROPRACTIC, PA
Entity type:Organization
Organization Name:NWA CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-435-1051
Mailing Address - Street 1:1502 W PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-4513
Mailing Address - Country:US
Mailing Address - Phone:479-633-8917
Mailing Address - Fax:479-340-0220
Practice Address - Street 1:1502 W PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-4513
Practice Address - Country:US
Practice Address - Phone:479-633-8917
Practice Address - Fax:479-340-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170494718Medicaid