Lakeside Chiropractic, PLLC
Organization Active NPI Clinic/Center · Higden, AR
NPI 1639627284 · NPPES record last updated Jan 9, 2023
Key facts
- NPI
- 1639627284
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 1724 (AR)
- Legal business name
- LAKESIDE CHIROPRACTIC, PLLC
- Practice address
- 5 Shiloh Rd
Higden, AR 72067-9521 - Phone
- (501) 825-7200
- NPI assigned
- Sep 12, 2016
- Organization subpart
- No
Authorized official
- Name
- William Jacob Smith, DO
- Title
- Owner
- Phone
- (501) 825-7200
Practitioners 6
-
William Jacob Smith, D.C
-
April Rene Fletcher, APRN
-
Alan B Carnathan, DC
-
Gary Shawn Fletcher, D.C.
-
Peter H Harris, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170524000993 | AR | Part B Supplier - Clinic/Group Practice | 8325315286 |
Receives reassigned benefits from 1 practitioner Practice locations: Greers Ferry, AR |
National Provider Directory
Locations
5 Shiloh Rd
Higden, AR 72067
Phone (501) 825-7200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 1724 | AR | Yes |
Addresses
Primary practice location
5 Shiloh Rd
Higden, AR 72067-9521
Mailing address
PO Box 115
Higden, AR 72067-0115
Phone (501) 825-7200
Other providers in Higden, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.