Provider Demographics
NPI:1861550048
Name:OZARK SPINAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:OZARK SPINAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-571-8400
Mailing Address - Street 1:2744 E MILLENNIUM PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4798
Mailing Address - Country:US
Mailing Address - Phone:479-571-8400
Mailing Address - Fax:479-571-8401
Practice Address - Street 1:2744 E MILLENNIUM PL
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4798
Practice Address - Country:US
Practice Address - Phone:479-571-8400
Practice Address - Fax:479-571-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C670OtherBCBS
AR5C670OtherBCBS