Provider Demographics
NPI:1679694566
Name:COMPLETE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:COMPLETE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-771-9993
Mailing Address - Street 1:3615 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8841
Mailing Address - Country:US
Mailing Address - Phone:501-771-9993
Mailing Address - Fax:501-771-9154
Practice Address - Street 1:3615 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8841
Practice Address - Country:US
Practice Address - Phone:501-771-9993
Practice Address - Fax:501-771-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U551Medicare ID - Type Unspecified
ARU77857Medicare UPIN