Healthcare Provider Details

I. General information

NPI: 1164984159
Provider Name (Legal Business Name): LINDSEY LILES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 AULENBROCK DR BLDG 200 STE B
CANTON MS
39046
US

IV. Provider business mailing address

551 E PEACE ST
CANTON MS
39046-4712
US

V. Phone/Fax

Practice location:
  • Phone: 662-809-2201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1302
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: