Healthcare Provider Details

I. General information

NPI: 1679740492
Provider Name (Legal Business Name): D AND F INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 PARK TEN DR
DIAMONDHEAD MS
39525-3222
US

IV. Provider business mailing address

4308 PARK TEN DR
DIAMONDHEAD MS
39525-3222
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-5328
  • Fax: 228-255-0026
Mailing address:
  • Phone: 228-255-5328
  • Fax: 228-255-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number887
License Number StateMS

VIII. Authorized Official

Name: DR. DESMOND W HODA
Title or Position: PRESIDENT
Credential: DC
Phone: 228-255-5328