MEDICARE: HALEY THOMASON MCCOLLUM DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1276	MS

General Provider Information

NPI Number	:	1164946398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY THOMASON MCCOLLUM DC

Provider Business Mailing Address
First Line	:	101 W WASHINGTON ST STE C1
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2434
Country	:	US
Telephone Number	:	601-856-2383
Fax Number	:	877-294-2560

Provider Business Practice Location Address
First Line	:	101 W WASHINGTON ST STE C1
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2434
Country	:	US
Telephone Number	:	601-856-2383
Fax Number	:	877-294-2560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	02/15/2019

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