Healthcare Provider Details

I. General information

NPI: 1215108162
Provider Name (Legal Business Name): BOSARGE FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302D HIGHWAY 613
MOSS POINT MS
39563-9312
US

IV. Provider business mailing address

PO BOX 2028
ESCATAWPA MS
39552-2028
US

V. Phone/Fax

Practice location:
  • Phone: 228-475-6437
  • Fax: 228-474-1325
Mailing address:
  • Phone: 228-475-6437
  • Fax: 228-474-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0867
License Number StateMS

VIII. Authorized Official

Name: DR. REJINA D BOSARGE
Title or Position: OWNER / OFFICE MANAGER
Credential: D.C.
Phone: 228-475-6437