Healthcare Provider Details

I. General information

NPI: 1427172303
Provider Name (Legal Business Name): BACK & NECK CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 PASS RD
BILOXI MS
39531-2633
US

IV. Provider business mailing address

2699 PASS RD
BILOXI MS
39531-2633
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-0088
  • Fax:
Mailing address:
  • Phone: 228-385-0088
  • Fax: 228-385-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0954
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12792
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR871245
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR690392
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR864120
License Number StateMS

VIII. Authorized Official

Name: DR. VINCENT MITCHELL
Title or Position: MEMBER-CHIROPRACTOR
Credential: DC
Phone: 228-385-0088