Southside Family Chiropractic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SOUTHSIDE FAMILY CHIROPRACTIC, LLC

Practice address

1997 Batesville Blvd
Southside, AR 72501-7896

Phone

(870) 613-1464

NPI assigned

Jul 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Blake Taylor, D.C.NPI 1821689605

Title

Owner/Practitioner

Phone

(870) 613-1464

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Blake Taylor, D.C.

  • Chiropractor
  • Southside, AR
  • NPI 1821689605

  AR

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1639741986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1997 BATESVILLE BLVD",
            "city": "SOUTHSIDE",
            "state": "AR",
            "postal_code": "725017896",
            "telephone_number": "870-613-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1997 BATESVILLE BLVD",
            "city": "SOUTHSIDE",
            "state": "AR",
            "postal_code": "725017896",
            "telephone_number": "870-613-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "870-613-1464",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Ann Moser, NURSE PRACTITIONER
• David Tanner Oliver, APRN
• Cheyenne Perkey
• Raheel Aurangzeb Qureshi, MD
• Jessica Marie Snelgrove, MD
• Steele Healthcare Services, PA
• Olivia Sturdivant, PTA
• Alexis Taylor
• Blake Taylor, D.C.
• Kathryn Tharp, FNP-BC

• All providers in Southside, AR
• Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.