Provider Demographics
NPI:1871902726
Name:RIVER VALLEY BACK AND NECK CLINIC, INC
Entity type:Organization
Organization Name:RIVER VALLEY BACK AND NECK CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:OSOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-785-0400
Mailing Address - Street 1:PO BOX 5322
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-5322
Mailing Address - Country:US
Mailing Address - Phone:479-785-0400
Mailing Address - Fax:479-785-3620
Practice Address - Street 1:2408 SOUTH 51ST CT.
Practice Address - Street 2:SUITE G
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3622
Practice Address - Country:US
Practice Address - Phone:479-785-0400
Practice Address - Fax:479-785-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty