Individual
DR. JOHN D TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1211 HWY 133 NORTH, CROSSETT, AR 71635
(870) 364-9540
(870) 364-9840
Mailing address
1211 HWY 133 NORTH, CROSSETT, AR 71635
(870) 364-9540
(870) 364-9840
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1148
LA
111N00000X
Chiropractor
Primary
1461
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133792718
—
AR
01
—
57685
GROUP NUMBER
—
Enumeration date
02/08/2006
Last updated
07/26/2010
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