Provider Demographics
NPI:1174535124
Name:PAIN CARE ASSOCIATES P A
Entity type:Organization
Organization Name:PAIN CARE ASSOCIATES P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-223-3314
Mailing Address - Street 1:8801 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2316
Mailing Address - Country:US
Mailing Address - Phone:501-223-3314
Mailing Address - Fax:501-223-8023
Practice Address - Street 1:8801 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2316
Practice Address - Country:US
Practice Address - Phone:501-223-3314
Practice Address - Fax:501-223-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B321OtherAR HEALTH ADVANTGE HMO
AR5B321OtherBLUE CROSS BLUE SHIELD
AR5B321OtherAR HEALTH ADVANTGE HMO