Healthcare Provider Details

I. General information

NPI: 1295821072
Provider Name (Legal Business Name): BUDDY LEE EADY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST 3RD ST.
FOREST MS
39074
US

IV. Provider business mailing address

3819 TANGLEWOOD RD
LAWRENCE MS
39336
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-3030
  • Fax: 601-469-2522
Mailing address:
  • Phone: 601-469-3030
  • Fax: 601-469-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1032
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: