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Individual
JUSTIN GREGORY FAVORITE
Active
Individual
JUSTIN GREGORY FAVORITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1676
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1676
STATE LISCENSE
AR
01
—
47-5357469
TAX ID
AR
Enumeration date
07/28/2006
Last updated
10/27/2020
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