Individual
JUSTIN GREGORY FAVORITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1127 S GUTENSOHN RD, STE. 110, SPRINGDALE, AR 72762-5228
(479) 756-1155
(479) 756-1130
Mailing address
693 WHITE RD STE E, SPRINGDALE, AR 72762-2918
(479) 756-1155
(479) 756-1130
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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