Amanda Rae Bledsoe, D.C.
Individual provider Active NPI Chiropractor · Conway, AR
NPI 1174583280 · NPPES record last updated Nov 6, 2023
Key facts
- NPI
- 1174583280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1663 (AR)
- Practice address
- 775 Amity Rd
Conway, AR 72032-5991 - Phone
- (501) 504-6999
- Fax
- (501) 205-8431
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Cleveland Chiropractic College - Kansas City, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Amanda Bledsoe Chiropractic Center, PLLC
Practice addresses (Care Compare)
775 Amity Rd
Conway, AR 72032-5991
Phone (501) 504-6999
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051206000910 | AR | Practitioner - Chiropractic | 4789604612 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1663 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amanda Bledsoe Chiropractic Center, PLLC | Chiropractor | Current |
Accepting new patients |
| Blackmon Chiropractic Clinic, P.a. | Chiropractor | Past |
Accepting new patients |
| Vilonia Chiropractic | Chiropractor | Past | Accepting new patients |
| Hurley Health PA | Past |
Accepting new patients | |
| Tracy Howard, DC,PA | Chiropractor | Past | Accepting new patients |
Locations
1155 Front St
Ste 1
Conway, AR 72032
Phone (501) 327-6672
9772 Maumelle Blvd
North Little Rock, AR 72113
Phone (501) 725-5432
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1663 | AR | Yes |
Addresses
Primary practice location
775 Amity Rd
Conway, AR 72032-5991
Mailing address
775 Amity Rd
Conway, AR 72032-5991
Phone (501) 504-6999
Other practice location 1
9772 Maumelle Blvd
North Little Rock, AR 72113-6737
Phone (501) 725-5432
NPI Registry JSON
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1174583280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "775 AMITY RD",
"city": "CONWAY",
"state": "AR",
"postal_code": "720325991",
"telephone_number": "501-504-6999",
"fax_number": "501-205-8431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 AMITY RD",
"city": "CONWAY",
"state": "AR",
"postal_code": "720325991",
"telephone_number": "501-504-6999",
"fax_number": "501-205-8431"
}
],
"practiceLocations": [
{
"address_1": "9772 Maumelle Blvd",
"address_purpose": "LOCATION",
"city": "North Little Rock",
"state": "AR",
"postal_code": "721136737",
"country_code": "US",
"telephone_number": "501-725-5432",
"fax_number": "501-205-8431",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLEDSOE",
"first_name": "AMANDA",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AR",
"license": "1663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.