Healthcare Provider Details

I. General information

NPI: 1215445903
Provider Name (Legal Business Name): PICAYUNE CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MEMORIAL BLVD
PICAYUNE MS
39466-5545
US

IV. Provider business mailing address

403 MEMORIAL BLVD
PICAYUNE MS
39466-5545
US

V. Phone/Fax

Practice location:
  • Phone: 601-799-2225
  • Fax: 601-799-4333
Mailing address:
  • Phone: 601-799-2225
  • Fax: 601-799-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1237
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN MICHAEL VARNADO
Title or Position: OWNER
Credential: DC
Phone: 601-799-2225