1790978443 NPI number — SPIERS CHIROPRACTIC CENTER

Table of content: (NPI 1790978443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790978443 NPI number — SPIERS CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPIERS CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790978443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5295 OLD HIGHWAY 11
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39402-6022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-261-9495
Provider Business Mailing Address Fax Number:
601-261-6997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5295 OLD HIGHWAY 11
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-6022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-261-9495
Provider Business Practice Location Address Fax Number:
601-261-6997
Provider Enumeration Date:
08/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPIERS
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
DENTON
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
601-261-9495

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0956 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)