Healthcare Provider Details

I. General information

NPI: 1962620385
Provider Name (Legal Business Name): LADNER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28284 HIGHWAY 603
PERKINSTON MS
39573-3793
US

IV. Provider business mailing address

28284 HIGHWAY 603
PERKINSTON MS
39573-3793
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-8099
  • Fax: 228-255-8098
Mailing address:
  • Phone: 228-255-8099
  • Fax: 228-255-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1080
License Number StateMS

VIII. Authorized Official

Name: MRS. DINELL MORAN
Title or Position: OFFICE MANAGER
Credential: CA
Phone: 228-255-8099