1770671703 NPI number — CHIROPRACTIC SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770671703 NPI number — CHIROPRACTIC SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC SERVICES INC.
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:
BROWN CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1770671703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4294 LAKELAND DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-9509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-936-6650
Provider Business Mailing Address Fax Number:
601-936-6665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4294 LAKELAND DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-9509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-936-6650
Provider Business Practice Location Address Fax Number:
601-936-6665
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
POLLY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OFFICE MGR.
Authorized Official Telephone Number:
601-936-6650

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MS917 , 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)

  • Identifier: 09014521 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH8502 . This is a "PALMETTO" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com