Elite Spine & Joint, PLLC
Clinic/Center in Benton, AR. Organization (NPI-2).
NPI number1699201376
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1699201376
- Entity type
- Organization (NPI-2)
- Legal business name
- Elite Spine & Joint, PLLC
- Organization subpart
- No
- Enumeration date
- May 2, 2017
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 16155 | AR | Yes |
Practice location
3309 WinchesterBenton, AR 72015-2896
Phone 501-575-0271 · Fax 501-575-0274
Mailing address
3309 WinchesterBenton, AR 72015-2896
Phone 501-575-0271 · Fax 501-575-0274
Authorized official
John Dylan Machycek
Owner
5016532225
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