Healthcare Provider Details

I. General information

NPI: 1629360896
Provider Name (Legal Business Name): LAURA STUBBS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5472 WATKINS DR STE C
JACKSON MS
39206-2000
US

IV. Provider business mailing address

5472 WATKINS DR STE C
JACKSON MS
39206-2000
US

V. Phone/Fax

Practice location:
  • Phone: 601-622-2998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1177
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: